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
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.
منابع مشابه
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.
BACKGROUND AND PURPOSE Intracranial mechanical thrombectomy is a therapeutic option for acute ischemic stroke patients failing intravenous tissue plasminogen activator (IV tPA). We compared patients treated by mechanical embolus removal in cerebral ischemia (MERCI) thrombectomy after failed IV tPA with those treated with thrombectomy alone. METHODS We pooled MERCI and Multi MERCI study patien...
متن کاملA cost-utility analysis of mechanical thrombectomy as an adjunct to intravenous tissue-type plasminogen activator for acute large-vessel ischemic stroke.
BACKGROUND AND PURPOSE Mechanical thrombectomy has the potential to improve recanalization rates and outcomes for patients with ischemic stroke, but potential gains could be offset by procedural complications and costs. We evaluated the cost and utility of combined intravenous (IV) tissue-type plasminogen activator (tPA) and mechanical thrombectomy compared to IV tPA alone for acute large-vesse...
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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...
متن کاملPredictors 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.
BACKGROUND AND PURPOSE The Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI trials evaluated the safety and efficacy of thrombectomy in the treatment of intracranial arterial occlusions within 8 hours of symptom onset. We sought to determine the predictors of clinical and angiographic outcomes in these patients. METHODS The trial cohorts were combined in a data set of 3...
متن کاملCost-Utility Analysis of Mechanical Thrombectomy
Ischemic stroke is the third highest cause of death in the United Kingdom and a leading cause of disability. The overall incidence is postulated to increase over the next 5 years by the WHO. The economic burden of stroke is estimated at £9 billion per year in the United Kingdom ($38 billion in the United States) and is estimated to rise. Intravenous tissue-type plasminogen activator (IV-tPA) fo...
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ورودعنوان ژورنال:
- AJNR. American journal of neuroradiology
دوره 27 6 شماره
صفحات -
تاریخ انتشار 2006