Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I.

نویسنده

  • W S Smith
چکیده

BACKGROUND The MERCI (Mechanical Embolus Removal in Cerebral Ischemia) trial reported efficacy of the Merci Retriever for opening intracranial vessels in patients ineligible for intravenous (IV) tissue plasminogen activator (tPA). Patients who receive IV tPA but do not recanalize may also benefit from thrombectomy, but the revascularization efficacy and safety of this strategy has not been reported. METHODS Multi MERCI is an ongoing international, multicenter, prospective, single-arm trial of patients with large vessel stroke treated within 8 hours of symptom onset. Patients were enrolled who had received IV tPA but did not recanalize or who were ineligible for IV tPA. Primary outcome was vascular recanalization (Thrombolysis in Myocardial Infarction [TIMI] score II/III) and safety. RESULTS One hundred eleven patients received the thrombectomy procedure. Mean age +/- SD was 66.2 +/- 17.0 years, and baseline National Institutes of Health Stroke Scale (NIHSS) score was 19 +/- 6.3. Thirty patients (27%) received IV tPA before intervention. Treatment with the Retriever alone resulted in successful recanalization in 60 of 111 (54%) treatable vessels and in 77 of 111 (69%) after adjunctive therapy (IA tPA, mechanical). Symptomatic intracranial hemorrhage (ICH) occurred in 10 of 111 (9.0%). Clinically significant procedural complications occurred in 5 of 111 (4.5%) patients. The symptomatic ICH rate was 2 of 30 (6.7%) in patients pretreated with IV tPA and 8 of 81 (9.9%) in those without (P > .99). CONCLUSIONS Mechanical thrombectomy after IV tPA seems as safe as mechanical thrombectomy alone. Mechanical thrombectomy with both first- and second-generation Merci devices is efficacious in opening intracranial vessels during acute ischemic stroke in patients who are either ineligible for IV fibrinolytic therapy or have failed IV fibrinolytic therapy.

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Endovascular thrombectomy for acute ischemic stroke in failed intravenous tissue plasminogen activator versus non-intravenous tissue plasminogen activator patients: revascularization and outcomes stratified by the site of arterial occlusions.

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Abbreviations: ACC American College of Cardiology, ACGME Accreditation Council for Graduate Medical Education, ECASS European Cooperative Acute Stroke Study, IA intra-arterial, ICH intracranial hemorrhage, IV intravenous, MCA middle cerebral artery, MELT Middle cerebral artery Embolism Local fibrinolytic intervention Trial, MERCI Mechanical Embolus Removal in Cerebral Ischemia [trial], mRS modi...

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Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials.

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Cost-Utility Analysis of Mechanical Thrombectomy

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عنوان ژورنال:
  • AJNR. American journal of neuroradiology

دوره 27 6  شماره 

صفحات  -

تاریخ انتشار 2006