Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial

Endovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices achieved recanalization rates of 48% and, when coupled with intraarterial thrombolytic drugs, recanalization rates of 60% have been reported. Enhan...

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Veröffentlicht in:	Stroke (1970) Jg. 39; H. 4; S. 1205
Hauptverfasser:	Smith, Wade S, Sung, Gene, Saver, Jeffrey, Budzik, Ronald, Duckwiler, Gary, Liebeskind, David S, Lutsep, Helmi L, Rymer, Marilyn M, Higashida, Randall T, Starkman, Sidney, Gobin, Y Pierre, Frei, Donald, Grobelny, Thomas, Hellinger, Frank, Huddle, Dan, Kidwell, Chelsea, Koroshetz, Walter, Marks, Michael, Nesbit, Gary, Silverman, Isaac E
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 01.04.2008
Schlagworte:	Acute Disease Aged Aged, 80 and over Brain Ischemia - drug therapy Brain Ischemia - mortality Brain Ischemia - surgery Combined Modality Therapy Equipment Design Female Fibrinolytic Agents - therapeutic use Humans Intracranial Thrombosis - drug therapy Intracranial Thrombosis - mortality Intracranial Thrombosis - surgery Male Middle Aged Prospective Studies Stroke - drug therapy Stroke - mortality Stroke - surgery Thrombectomy - instrumentation Thrombectomy - methods Thrombectomy - mortality Treatment Outcome
ISSN:	1524-4628, 1524-4628
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Abstract	Endovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices achieved recanalization rates of 48% and, when coupled with intraarterial thrombolytic drugs, recanalization rates of 60% have been reported. Enhancements in embolectomy device design may improve recanalization rates. Multi MERCI was an international, multicenter, prospective, single-arm trial of thrombectomy in patients with large vessel stroke treated within 8 hours of symptom onset. Patients with persistent large vessel occlusion after IV tissue plasminogen activator treatment were included. Once the newer generation (L5 Retriever) device became available, investigators were instructed to use the L5 Retriever to open vessels and could subsequently use older generation devices and/or intraarterial tissue plasminogen activator. Primary outcome was recanalization of the target vessel. One hundred sixty-four patients received thrombectomy and 131 were initially treated with the L5 Retriever. Mean age+/-SD was 68+/-16 years, and baseline median (interquartile range) National Institutes of Health Stroke Scale score was 19 (15 to 23). Treatment with the L5 Retriever resulted in successful recanalization in 75 of 131 (57.3%) treatable vessels and in 91 of 131 (69.5%) after adjunctive therapy (intraarterial tissue plasminogen activator, mechanical). Overall, favorable clinical outcomes (modified Rankin Scale 0 to 2) occurred in 36% and mortality was 34%; both outcomes were significantly related to vascular recanalization. Symptomatic intracerebral hemorrhage occurred in 16 patients (9.8%); 4 (2.4%) of these were parenchymal hematoma type II. Clinically significant procedural complications occurred in 9 (5.5%) patients. Higher rates of recanalization were associated with a newer generation thrombectomy device compared with first-generation devices, but these differences did not achieve statistical significance. Mortality trended lower and the proportion of good clinical outcomes trended higher, consistent with better recanalization.
AbstractList	Endovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices achieved recanalization rates of 48% and, when coupled with intraarterial thrombolytic drugs, recanalization rates of 60% have been reported. Enhancements in embolectomy device design may improve recanalization rates.BACKGROUND AND PURPOSEEndovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices achieved recanalization rates of 48% and, when coupled with intraarterial thrombolytic drugs, recanalization rates of 60% have been reported. Enhancements in embolectomy device design may improve recanalization rates.Multi MERCI was an international, multicenter, prospective, single-arm trial of thrombectomy in patients with large vessel stroke treated within 8 hours of symptom onset. Patients with persistent large vessel occlusion after IV tissue plasminogen activator treatment were included. Once the newer generation (L5 Retriever) device became available, investigators were instructed to use the L5 Retriever to open vessels and could subsequently use older generation devices and/or intraarterial tissue plasminogen activator. Primary outcome was recanalization of the target vessel.METHODSMulti MERCI was an international, multicenter, prospective, single-arm trial of thrombectomy in patients with large vessel stroke treated within 8 hours of symptom onset. Patients with persistent large vessel occlusion after IV tissue plasminogen activator treatment were included. Once the newer generation (L5 Retriever) device became available, investigators were instructed to use the L5 Retriever to open vessels and could subsequently use older generation devices and/or intraarterial tissue plasminogen activator. Primary outcome was recanalization of the target vessel.One hundred sixty-four patients received thrombectomy and 131 were initially treated with the L5 Retriever. Mean age+/-SD was 68+/-16 years, and baseline median (interquartile range) National Institutes of Health Stroke Scale score was 19 (15 to 23). Treatment with the L5 Retriever resulted in successful recanalization in 75 of 131 (57.3%) treatable vessels and in 91 of 131 (69.5%) after adjunctive therapy (intraarterial tissue plasminogen activator, mechanical). Overall, favorable clinical outcomes (modified Rankin Scale 0 to 2) occurred in 36% and mortality was 34%; both outcomes were significantly related to vascular recanalization. Symptomatic intracerebral hemorrhage occurred in 16 patients (9.8%); 4 (2.4%) of these were parenchymal hematoma type II. Clinically significant procedural complications occurred in 9 (5.5%) patients.RESULTSOne hundred sixty-four patients received thrombectomy and 131 were initially treated with the L5 Retriever. Mean age+/-SD was 68+/-16 years, and baseline median (interquartile range) National Institutes of Health Stroke Scale score was 19 (15 to 23). Treatment with the L5 Retriever resulted in successful recanalization in 75 of 131 (57.3%) treatable vessels and in 91 of 131 (69.5%) after adjunctive therapy (intraarterial tissue plasminogen activator, mechanical). Overall, favorable clinical outcomes (modified Rankin Scale 0 to 2) occurred in 36% and mortality was 34%; both outcomes were significantly related to vascular recanalization. Symptomatic intracerebral hemorrhage occurred in 16 patients (9.8%); 4 (2.4%) of these were parenchymal hematoma type II. Clinically significant procedural complications occurred in 9 (5.5%) patients.Higher rates of recanalization were associated with a newer generation thrombectomy device compared with first-generation devices, but these differences did not achieve statistical significance. Mortality trended lower and the proportion of good clinical outcomes trended higher, consistent with better recanalization.CONCLUSIONSHigher rates of recanalization were associated with a newer generation thrombectomy device compared with first-generation devices, but these differences did not achieve statistical significance. Mortality trended lower and the proportion of good clinical outcomes trended higher, consistent with better recanalization. Endovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices achieved recanalization rates of 48% and, when coupled with intraarterial thrombolytic drugs, recanalization rates of 60% have been reported. Enhancements in embolectomy device design may improve recanalization rates. Multi MERCI was an international, multicenter, prospective, single-arm trial of thrombectomy in patients with large vessel stroke treated within 8 hours of symptom onset. Patients with persistent large vessel occlusion after IV tissue plasminogen activator treatment were included. Once the newer generation (L5 Retriever) device became available, investigators were instructed to use the L5 Retriever to open vessels and could subsequently use older generation devices and/or intraarterial tissue plasminogen activator. Primary outcome was recanalization of the target vessel. One hundred sixty-four patients received thrombectomy and 131 were initially treated with the L5 Retriever. Mean age+/-SD was 68+/-16 years, and baseline median (interquartile range) National Institutes of Health Stroke Scale score was 19 (15 to 23). Treatment with the L5 Retriever resulted in successful recanalization in 75 of 131 (57.3%) treatable vessels and in 91 of 131 (69.5%) after adjunctive therapy (intraarterial tissue plasminogen activator, mechanical). Overall, favorable clinical outcomes (modified Rankin Scale 0 to 2) occurred in 36% and mortality was 34%; both outcomes were significantly related to vascular recanalization. Symptomatic intracerebral hemorrhage occurred in 16 patients (9.8%); 4 (2.4%) of these were parenchymal hematoma type II. Clinically significant procedural complications occurred in 9 (5.5%) patients. Higher rates of recanalization were associated with a newer generation thrombectomy device compared with first-generation devices, but these differences did not achieve statistical significance. Mortality trended lower and the proportion of good clinical outcomes trended higher, consistent with better recanalization.
Author	Lutsep, Helmi L Starkman, Sidney Smith, Wade S Liebeskind, David S Budzik, Ronald Marks, Michael Koroshetz, Walter Hellinger, Frank Kidwell, Chelsea Higashida, Randall T Rymer, Marilyn M Frei, Donald Gobin, Y Pierre Silverman, Isaac E Nesbit, Gary Duckwiler, Gary Sung, Gene Saver, Jeffrey Grobelny, Thomas Huddle, Dan
Author_xml	– sequence: 1 givenname: Wade S surname: Smith fullname: Smith, Wade S email: smithw@neurology.ucsf.edu organization: Department of Neurology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0114, USA. smithw@neurology.ucsf.edu – sequence: 2 givenname: Gene surname: Sung fullname: Sung, Gene – sequence: 3 givenname: Jeffrey surname: Saver fullname: Saver, Jeffrey – sequence: 4 givenname: Ronald surname: Budzik fullname: Budzik, Ronald – sequence: 5 givenname: Gary surname: Duckwiler fullname: Duckwiler, Gary – sequence: 6 givenname: David S surname: Liebeskind fullname: Liebeskind, David S – sequence: 7 givenname: Helmi L surname: Lutsep fullname: Lutsep, Helmi L – sequence: 8 givenname: Marilyn M surname: Rymer fullname: Rymer, Marilyn M – sequence: 9 givenname: Randall T surname: Higashida fullname: Higashida, Randall T – sequence: 10 givenname: Sidney surname: Starkman fullname: Starkman, Sidney – sequence: 11 givenname: Y Pierre surname: Gobin fullname: Gobin, Y Pierre – sequence: 12 givenname: Donald surname: Frei fullname: Frei, Donald – sequence: 13 givenname: Thomas surname: Grobelny fullname: Grobelny, Thomas – sequence: 14 givenname: Frank surname: Hellinger fullname: Hellinger, Frank – sequence: 15 givenname: Dan surname: Huddle fullname: Huddle, Dan – sequence: 16 givenname: Chelsea surname: Kidwell fullname: Kidwell, Chelsea – sequence: 17 givenname: Walter surname: Koroshetz fullname: Koroshetz, Walter – sequence: 18 givenname: Michael surname: Marks fullname: Marks, Michael – sequence: 19 givenname: Gary surname: Nesbit fullname: Nesbit, Gary – sequence: 20 givenname: Isaac E surname: Silverman fullname: Silverman, Isaac E
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/18309168$$D View this record in MEDLINE/PubMed
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Snippet	Endovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices...
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SubjectTerms	Acute Disease Aged Aged, 80 and over Brain Ischemia - drug therapy Brain Ischemia - mortality Brain Ischemia - surgery Combined Modality Therapy Equipment Design Female Fibrinolytic Agents - therapeutic use Humans Intracranial Thrombosis - drug therapy Intracranial Thrombosis - mortality Intracranial Thrombosis - surgery Male Middle Aged Prospective Studies Stroke - drug therapy Stroke - mortality Stroke - surgery Thrombectomy - instrumentation Thrombectomy - methods Thrombectomy - mortality Treatment Outcome
Title	Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial
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