Merci mechanical thrombectomy retriever for acute ischemic stroke therapy

Alshekhlee, Amer; Pandya, Dhruvil; English, Joey; Zaidat, Osama O.; Mueller, Nils; Gupta, Rishi; Nogueira, Raul G

doi:10.1212/wnl.0b013e3182697e89

Cited by 24 publications

(19 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The combination of intravenous and potentially subsequent intra-arterial or clot retrieval treatments may prove to be very effective in the continued improvement of recanalization rates [77]. Current device options which have been closely studied for mechanical retrieval include the MERCI retrieval system, Penumbra aspiration system, SOLITAIRE flow restoration device and TREVO stent-like retriever [78,79,80,81], which allow for treatment in an extended time window typically under 8 h following symptom onset. When taken together, these treatments collectively aim at recanalization and subsequent reperfusion by treatment of the occlusive lesion responsible for initial parenchymal ischemia.…”

Section: Reperfusion Strategiesmentioning

confidence: 99%

Ischemia-Reperfusion Injury in Stroke

2012

View full text Add to dashboard Cite

Despite ongoing advances in stroke imaging and treatment, ischemic and hemorrhagic stroke continue to debilitate patients with devastating outcomes at both the personal and societal levels. While the ultimate goal of therapy in ischemic stroke is geared towards restoration of blood flow, even when mitigation of initial tissue hypoxia is successful, exacerbation of tissue injury may occur in the form of cell death, or alternatively, hemorrhagic transformation of reperfused tissue. Animal models have extensively demonstrated the concept of reperfusion injury at the molecular and cellular levels, yet no study has quantified this effect in stroke patients. These preclinical models have also demonstrated the success of a wide array of neuroprotective strategies at lessening the deleterious effects of reperfusion injury. Serial multimodal imaging may provide a framework for developing therapies for reperfusion injury.

show abstract

Section: Reperfusion Strategiesmentioning

confidence: 99%

Ischemia-Reperfusion Injury in Stroke

2012

View full text Add to dashboard Cite

show abstract

“…Also, as recanalisation rates decrease with increasing thrombectomy attempts [53], mechanical thrombectomy devices have to be optimised to a wide range of possible thrombus types to be successful. cleared by the US Food and Drug Administration (FDA) as the fi rst mechanical thrombectomy device for removing thrombus in ischaemic stroke patients [54]. The downside of the MERCI retriever was modest recanalisation rates.…”

Section: How Do We Better Understand the Thrombus To Adapt Devices Anmentioning

confidence: 99%

“…The downside of the MERCI retriever was modest recanalisation rates. Earlier versions of the Penumbra aspiration system were comparable in effi cacy, safety and clinical outcome [54,55]. Novel methods for mechanical thrombectomy continue to emerge.…”

Section: How Do We Better Understand the Thrombus To Adapt Devices Anmentioning

confidence: 99%

Endovascular treatment of ischaemic stroke patients - new evidence and old challenges

Gerber

Puetz

Bodechtel

et al. 2016

Vasa

View full text Add to dashboard Cite

Summary: An overwhelming benefi t from endovascular treatment of ischaemic stroke could be shown in recent clinical trials, making it the new evidence-based standard of care for ischaemic stroke due to large vessel occlusion. To provide all eligible stroke patients with this therapy at any time, stroke networks and hospitals should streamline their workfl ow to rapidly image, select, and treat stroke patients. Interdisciplinary cooperation is vital for effective emergency endovascular stroke treatment, which is one of the most complex multidisciplinary functions a hospital can undertake.

show abstract

“…These two devices were approved in Japan in 2010 and 2011, respectively. Such devices show a high recanalization rate and symptomatic intracerebral hemorrhage in about 10% of the patients [10,11,12,13,14], although the International Management of Stroke Trial 3 failed to show the superiority of mechanical thrombectomy or additional endovascular therapy to rt-PA therapy alone [15,16]. Recently, retrievable stents showed more promising results [17,18].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Early Recanalization Failure following Intravenous rt-PA Therapy for Ischemic Stroke

Koga¹,

Arihiro²,

Miyashita³

et al. 2013

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: Although intravenous recombinant tissue-type plasminogen activator (rt-PA) therapy can be effective for ischemic stroke, a considerable percentage of patients do not receive any benefit as a result of early recanalization failure. We aimed to investigate the factors associated with early recanalization failure following intravenous rt-PA therapy. Methods: Patients with acute ischemic stroke and internal carotid artery (ICA) or middle cerebral artery occlusion on initial magnetic resonance angiography (MRA) who received intravenous rt-PA therapy within 3 h of stroke onset and underwent follow-up MRA within 8 h after treatment were enrolled. Baseline characteristics, stroke features, onset to treatment time, initial National Institutes of Health Stroke Scale (NIHSS) score, initial Alberta Stroke Programme Early CT Score on diffusion-weighted imaging-ASPECTS (Alberta Stroke Program Early Computed Tomography Score), the presence of ICA or M1 origin (the residual length <5 mm) (ICA/M1 origin occlusion), initial vital signs, and laboratory findings were recorded. Early recanalization on the follow-up MRA within 8 h was evaluated by modified Mori grade: grade 0, no reperfusion; grade 1, movement of thrombus; grade 2, partial recanalization, and grade 3, complete recanalization. Results: Seventy subjects (35 women, 77 ± 12 years) were enrolled. The median (interquartile range: IQR)NIHSS score was 18 (12.5-24), and the mean onset to treatment time was 141 ± 54 min. ICA was occluded in 29%, M1 origin in 17%, M1 middle in 13%, M1 distal in 26% and M2 in 15%. The median (IQR) pretreatment diffusion weighted imaging-ASPECTS was 8 (6-9), and follow-up time of MRA was 65 min (59-70) after rt-PA therapy. Thirty-two subjects (46%) showed modified Mori grade 0; 10 (14%), grade 1; 9 (13%), grade 2, and 19 (27%), grade 3. Multivariate analyses revealed ICA/M1 origin occlusion (OR 3.71, 95% CI 1.03-14.87, p = 0.044), and C-reactive protein (per 0.1-mg/dl increment, OR 1.19, 95% CI 1.03-1.44, p = 0.013) were independently associated with subjects with no recanalization (grade 0-1), whereas age (per years old, OR 0.93, 95% CI 0.86-0.99, p = 0.014) and high-density lipoprotein cholesterol (per 1-mg/dl increment, OR 0.94, 95% CI 0.89-0.98, p = 0.004) were inversely associated with those. Conclusion: ICA/M1 origin occlusion and C-reactive protein were positively and high-density lipoprotein cholesterol was negatively associated with early recanalization failure.

show abstract

Merci mechanical thrombectomy retriever for acute ischemic stroke therapy

Abstract: Background: Mechanical thrombectomy is a promising adjuvant or stand-alone therapy for acute

Cited by 24 publications

References 21 publications

Ischemia-Reperfusion Injury in Stroke

Ischemia-Reperfusion Injury in Stroke

Endovascular treatment of ischaemic stroke patients - new evidence and old challenges

Factors Associated with Early Recanalization Failure following Intravenous rt-PA Therapy for Ischemic Stroke

Contact Info

Product

Resources

About