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(Stroke. 2005;36:1432.)
© 2005 American Heart Association, Inc.

Original Contributions

Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke

Results of the MERCI Trial

Wade S. Smith, MD, PhD; Gene Sung, MD; Sidney Starkman, MD; Jeffrey L. Saver, MD; Chelsea S. Kidwell, MD; Y.Pierre Gobin, MD; Helmi L. Lutsep, MD; Gary M. Nesbit, MD; Thomas Grobelny, MD; Marilyn M. Rymer, MD; Isaac E. Silverman, MD; Randall T. Higashida, MD; Ronald F. Budzik, MD; Michael P. Marks, MD for the MERCI Trial Investigators

From University of California, San Francisco, Department of Neurology (W.S.S.), San Francisco, Calif; the Department of Neurology (G.S.), University of Southern California, Los Angeles; the Department of Neurology (S.S., J.L.S.) and the Department of Emergency Medicine (S.S.), University of California, Los Angeles; the Division of Interventional Neuroradiology (Y.P.G.), Weill Cornell Medical College, New York, NY; Oregon Health Science University (H.L.L., G.M.N.), Portland; Saint Luke’s Hospital (T.G., M.M.R.), Kansas City, Mo; Hartford Hospital (I.E.S.), Hartford, Conn; Department of Radiology (R.T.H.), University of California, San Francisco; Riverside Methodist Hospital (R.F.B.), Columbus, Ohio; and the Department of Radiology (M.P.M.), Stanford University, Palo Alto, Calif.

Correspondence to Wade S. Smith, MD, PhD, University of California, San Francisco, Department of Neurology, 505 Parnassus Avenue, San Francisco, CA 94143-0114. E-mail smithw{at}neurology.ucsf.edu

Background and Purpose— The only Food and Drug Administration (FDA)-approved treatment for acute ischemic stroke is tissue plasminogen activator (tPA) given intravenously within 3 hours of symptom onset. An alternative strategy for opening intracranial vessels during stroke is mechanical embolectomy, especially for patients ineligible for intravenous tPA.

Methods— We investigated the safety and efficacy of a novel embolectomy device (Merci Retriever) to open occluded intracranial large vessels within 8 hours of the onset of stroke symptoms in a prospective, nonrandomized, multicenter trial. All patients were ineligible for intravenous tPA. Primary outcomes were recanalization and safety, and secondary outcomes were neurological outcome at 90 days in recanalized versus nonrecanalized patients.

Results— Recanalization was achieved in 46% (69/151) of patients on intention to treat analysis, and in 48% (68/141) of patients in whom the device was deployed. This rate is significantly higher than that expected using an historical control of 18% (P<0.0001). Clinically significant procedural complications occurred in 10 of 141 (7.1%) patients. Symptomatic intracranial hemorrhages was observed in 11 of 141 (7.8%) patients. Good neurological outcomes (modified Rankin score 2) were more frequent at 90 days in patients with successful recanalization compared with patients with unsuccessful recanalization (46% versus 10%; relative risk [RR], 4.4; 95% CI, 2.1 to 9.3; P<0.0001), and mortality was less (32% versus 54%; RR, 0.59; 95% CI, 0.39 to 0.89; P=0.01).

Conclusions— A novel endovascular embolectomy device can significantly restore vascular patency during acute ischemic stroke within 8 hours of stroke symptom onset and provides an alternative intervention for patients who are otherwise ineligible for thrombolytics.

Key Words: angiography • embolism • embolectomy • ischemia • reperfusion • stroke, acute • thrombectomy • treatment outcome

Related Article:

Editorial Comment—Mechanical Embolus Removal: A New Day Dawning

Thomas A. Tomsick
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				M. Saqqur, C. A. Molina, A. Salam, M. Siddiqui, M. Ribo, K. Uchino, S. Calleja, Z. Garami, K. Khan, N. Akhtar, et al. Clinical Deterioration After Intravenous Recombinant Tissue Plasminogen Activator Treatment: A Multicenter Transcranial Doppler Study Stroke, January 1, 2007; 38(1): 69 - 74. [Abstract] [Full Text] [PDF]

				J. Gralla, G. Schroth, L. Remonda, K. Nedeltchev, J. Slotboom, and C. Brekenfeld Mechanical Thrombectomy for Acute Ischemic Stroke: Thrombus-Device Interaction, Efficiency, and Complications In Vivo Stroke, December 1, 2006; 37(12): 3019 - 3024. [Abstract] [Full Text] [PDF]

				J. Dawson and M. Walters New and emerging treatments for stroke Br. Med. Bull., November 7, 2006; (2006) ldl011v1. [Abstract] [Full Text] [PDF]

				T. A. Tomsick 2006: A Stroke Odyssey AJNR Am. J. Neuroradiol., November 1, 2006; 27(10): 2019 - 2021. [Full Text] [PDF]

				D. Kim, R. Jahan, S. Starkman, A. Abolian, C.S. Kidwell, F. Vinuela, G.R. Duckwiler, B. Ovbiagele, P.M. Vespa, S. Selco, et al. Endovascular Mechanical Clot Retrieval in a Broad Ischemic Stroke Cohort AJNR Am. J. Neuroradiol., November 1, 2006; 27(10): 2048 - 2052. [Abstract] [Full Text] [PDF]

				E.I. Levy, E. Sauvageau, R.A. Hanel, R. Parikh, and L.N. Hopkins Self-Expanding Versus Balloon-Mounted Stents for Vessel Recanalization Following Embolic Occlusion in the Canine Model: Technical Feasibility Study AJNR Am. J. Neuroradiol., November 1, 2006; 27(10): 2069 - 2072. [Abstract] [Full Text] [PDF]

				S. M. Davis and G. A. Donnan Basilar Artery Thrombosis: Recanalization Is the Key Stroke, September 1, 2006; 37(9): 2440 - 2440. [Full Text] [PDF]

				K. Imai, T. Mori, H. Izumoto, N. Takabatake, T. Kunieda, H. Shimizu, and M. Watanabe Clot Removal Therapy by Aspiration and Extraction for Acute Embolic Carotid Occlusion AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1521 - 1527. [Abstract] [Full Text] [PDF]

				V. J. Marder, D. J. Chute, S. Starkman, A. M. Abolian, C. Kidwell, D. Liebeskind, B. Ovbiagele, F. Vinuela, G. Duckwiler, R. Jahan, et al. Analysis of Thrombi Retrieved From Cerebral Arteries of Patients With Acute Ischemic Stroke Stroke, August 1, 2006; 37(8): 2086 - 2093. [Abstract] [Full Text] [PDF]

				A. Ciccone and F. Scomazzoni Intra-Arterial Thrombolysis for Acute Ischemic Stroke Stroke, August 1, 2006; 37(8): 1962 - 1962. [Full Text] [PDF]

				L. R. Caplan Stroke Thrombolysis: Slow Progress Circulation, July 18, 2006; 114(3): 187 - 190. [Full Text] [PDF]

				W.S. Smith and for the Multi MERCI Investigators 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 AJNR Am. J. Neuroradiol., June 1, 2006; 27(6): 1177 - 1182. [Abstract] [Full Text] [PDF]

				P. Khatri and S. E. Kasner Ischemic strokes after cardiac catheterization: opportune thrombolysis candidates? Arch Neurol, June 1, 2006; 63(6): 817 - 821. [Abstract] [Full Text] [PDF]

				S. H. Thomas, L. H. Schwamm, and M. H. Lev Case records of the Massachusetts General Hospital. Case 16-2006. A 72-year-old woman admitted to the emergency department because of a sudden change in mental status. N. Engl. J. Med., May 25, 2006; 354(21): 2263 - 2271. [Full Text] [PDF]

				L. R. Wechsler Does the Merci Retriever Work?: Against Stroke, May 1, 2006; 37(5): 1341 - 1342. [Full Text] [PDF]

				J. L. Saver Does the Merci Retriever Work?: For Stroke, May 1, 2006; 37(5): 1340 - 1341. [Full Text] [PDF]

				R.G. Gonzalez Imaging-guided acute ischemic stroke therapy: From "time is brain" to "physiology is brain". AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 728 - 735. [Abstract] [Full Text] [PDF]

				R. Gupta, N. A. Vora, M. B. Horowitz, A. H. Tayal, M. D. Hammer, K. Uchino, E. I. Levy, L. R. Wechsler, and T. G. Jovin Multimodal Reperfusion Therapy for Acute Ischemic Stroke: Factors Predicting Vessel Recanalization Stroke, April 1, 2006; 37(4): 986 - 990. [Abstract] [Full Text] [PDF]

				P. J. Lindsberg and H. P. Mattle Therapy of Basilar Artery Occlusion: A Systematic Analysis Comparing Intra-Arterial and Intravenous Thrombolysis Stroke, March 1, 2006; 37(3): 922 - 928. [Abstract] [Full Text] [PDF]

				P. A. Ringleb Thrombolytics, Anticoagulants, and Antiplatelet Agents Stroke, February 1, 2006; 37(2): 312 - 313. [Full Text] [PDF]

				D. Pelz, T. Andersson, M. Soderman, P. Lylyk, and M. Negoro Advances in Interventional Neuroradiology 2005 Stroke, February 1, 2006; 37(2): 309 - 311. [Full Text] [PDF]

				M. Bergui, G. Stura, D. Daniele, P. Cerrato, M. Berardino, and G. B. Bradac Mechanical Thrombolysis in Ischemic Stroke Attributable to Basilar Artery Occlusion as First-Line Treatment Stroke, January 1, 2006; 37(1): 145 - 150. [Abstract] [Full Text] [PDF]

				Embolectomy for Acute Ischemic Stroke: A Novel Treatment with Promising Results Journal Watch Neurology, October 6, 2005; 2005(1006): 2 - 2. [Full Text]