Donate Help Contact The AHA Sign In Home
American Heart Association
Stroke
Search: search_blue_button Advanced Search
Stroke. 2008;39:1205-1212
Published online before print February 28, 2008, doi: 10.1161/STROKEAHA.107.497115
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
39/4/1205    most recent
STROKEAHA.107.497115v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Smith, W. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Smith, W. S.
Related Collections
Right arrow Acute Cerebral Infarction
Right arrow Embolic stroke
Right arrow Angiography
Right arrow Other Stroke Treatment - Surgical

(Stroke. 2008;39:1205.)
© 2008 American Heart Association, Inc.


Original Contributions

Mechanical Thrombectomy for Acute Ischemic Stroke

Final Results of the Multi MERCI Trial

Wade S. Smith, MD, PhD; Gene Sung, MD, MPH; Jeffrey Saver, MD; Ronald Budzik, MD; Gary Duckwiler, MD; David S. Liebeskind, MD; Helmi L. Lutsep, MD; Marilyn M. Rymer, MD; Randall T. Higashida, MD; Sidney Starkman, MD; Y. Pierre Gobin, MD for the Multi MERCI Investigators

From the Departments of Neurology (W.S.S.) and Radiology (R.T.H.), University of California, San Francisco, San Francisco, Calif; the Department of Neurology (G.S.), University of Southern California, Los Angeles, Calif; the Departments of Neurology (J.S., D.S.L.), Radiology (G.D.), and Emergency Medicine (S.S.), University of California, Los Angeles, Los Angeles, Calif; Riverside Methodist Hospital (R.B.), Columbus, Ohio; Oregon Health Sciences (H.L.L.), Portland, Ore; St Luke’s Hospital (M.M.R.), Kansas City, Kan; and the Department of Radiology (Y.P.G.), New York Presbyterian Hospital–Cornell, New York, NY.

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

Background and Purpose— 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.

Methods— 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.

Results— 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.

Conclusions— 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.


Key Words: acute stroke • fibrinolytic • thrombectomy




This article has been cited by other articles:


Home page
StrokeHome page
K. McArthur and K. R. Lees
Advances in Emerging Therapies 2009
Stroke, February 1, 2010; 41(2): e67 - e70.
[Full Text] [PDF]


Home page
StrokeHome page
J. L. Saver, D. S. Liebeskind, R. G. Nogueira, and R. Jahan
Need to Clarify Thrombolysis In Myocardial Ischemia (TIMI) Scale Scoring Method in the Penumbra Pivotal Stroke Trial
Stroke, February 1, 2010; 41(2): e115 - e116.
[Full Text] [PDF]


Home page
Journal of NeuroInterventional SurgeryHome page
R M Jha, L R Hochberg, R Hakimelahi, J A Hirsch, R G Gonzalez, and A J Yoo
Hyperacute stent placement in acute cervical internal carotid artery occlusions: the potential role of magnetic resonance imaging
JNIS, December 1, 2009; 1(2): 171 - 174.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
R. G. Nogueira, D. S. Liebeskind, G. Sung, G. Duckwiler, W. S. Smith, and on Behalf of the MERCI; and Multi MERCI Writing Co
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
Stroke, December 1, 2009; 40(12): 3777 - 3783.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
E. I. Levy, A. H. Siddiqui, A. Crumlish, K. V. Snyder, E. F. Hauck, D. J. Fiorella, L. N. Hopkins, and J Mocco
First Food and Drug Administration-Approved Prospective Trial of Primary Intracranial Stenting for Acute Stroke: SARIS (Stent-Assisted Recanalization in Acute Ischemic Stroke)
Stroke, November 1, 2009; 40(11): 3552 - 3556.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
S. K. Natarajan, K. V. Snyder, A. H. Siddiqui, C. C. Ionita, L. N. Hopkins, and E. I. Levy
Safety and Effectiveness of Endovascular Therapy After 8 Hours of Acute Ischemic Stroke Onset and Wake-Up Strokes
Stroke, October 1, 2009; 40(10): 3269 - 3274.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
P. S. Vosler, S. H. Graham, L. R. Wechsler, and J. Chen
Mitochondrial Targets for Stroke: Focusing Basic Science Research Toward Development of Clinically Translatable Therapeutics
Stroke, September 1, 2009; 40(9): 3149 - 3155.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
The Penumbra Pivotal Stroke Trial Investigators
The Penumbra Pivotal Stroke Trial: Safety and Effectiveness of a New Generation of Mechanical Devices for Clot Removal in Intracranial Large Vessel Occlusive Disease
Stroke, August 1, 2009; 40(8): 2761 - 2768.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
S. B. Coutts and M. Goyal
When Recanalization Does Not Improve Clinical Outcomes
Stroke, August 1, 2009; 40(8): 2661 - 2661.
[Full Text] [PDF]


Home page
Journal of NeuroInterventional SurgeryHome page
R Novakovic, G Toth, and P D Purdy
Review of current and emerging therapies in acute ischemic stroke
JNIS, July 1, 2009; 1(1): 13 - 26.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
M. Moonis
Intraarterial Thrombolysis Within the First Three Hours After Acute Ischemic Stroke in Selected Patients
Stroke, July 1, 2009; 40(7): 2611 - 2612.
[Full Text] [PDF]


Home page
StrokeHome page
J. L. Saver, G. W. Albers, B. Dunn, K. C. Johnston, M. Fisher, and for the STAIR VI Consortium
Stroke Therapy Academic Industry Roundtable (STAIR) Recommendations for Extended Window Acute Stroke Therapy Trials
Stroke, July 1, 2009; 40(7): 2594 - 2600.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
A. J. Yoo, L. A. Verduzco, P. W. Schaefer, J. A. Hirsch, J. D. Rabinov, and R. G. Gonzalez
MRI-Based Selection for Intra-Arterial Stroke Therapy: Value of Pretreatment Diffusion-Weighted Imaging Lesion Volume in Selecting Patients With Acute Stroke Who Will Benefit From Early Recanalization
Stroke, June 1, 2009; 40(6): 2046 - 2054.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
W. W. Wasiewski and K. C. Johnston
Clinical Trials, Devices, Unproven Treatments, and Clinical Equipoise
Stroke, June 1, 2009; 40(6): e441 - e442.
[Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
R.G. Nogueira, A.J. Yoo, F.S. Buonanno, and J.A. Hirsch
Endovascular Approaches to Acute Stroke, Part 2: A Comprehensive Review of Studies and Trials
AJNR Am. J. Neuroradiol., May 1, 2009; 30(5): 859 - 875.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
N. Janjua, A. El-Gengaihy, J. Pile-Spellman, and A.I. Qureshi
Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch
AJNR Am. J. Neuroradiol., May 1, 2009; 30(5): 1024 - 1027.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
A. K. Wakhloo, M. J. Deleo III, and M. M. Brown
Advances in Interventional Neuroradiology
Stroke, May 1, 2009; 40(5): e305 - e312.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
P. M. Meyers, H. C. Schumacher, R. T. Higashida, S. L. Barnwell, M. A. Creager, R. Gupta, C. G. McDougall, D. K. Pandey, D. Sacks, and L. R. Wechsler
Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research
Circulation, April 28, 2009; 119(16): 2235 - 2249.
[Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
L.E. Cipriano, M.L. Steinberg, G.S. Gazelle, and R.G. Gonzalez
Comparing and Predicting the Costs and Outcomes of Patients with Major and Minor Stroke Using the Boston Acute Stroke Imaging Scale Neuroimaging Classification System
AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 703 - 709.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
R.G. Nogueira, L.H. Schwamm, and J.A. Hirsch
Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data
AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 649 - 661.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
H.J. Cloft, A. Rabinstein, G. Lanzino, and D.F. Kallmes
Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force
AJNR Am. J. Neuroradiol., March 1, 2009; 30(3): 453 - 458.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
C. Brekenfeld, G. Schroth, H. P. Mattle, D.-D. Do, L. Remonda, P. Mordasini, M. Arnold, K. Nedeltchev, N. Meier, and J. Gralla
Stent Placement in Acute Cerebral Artery Occlusion: Use of a Self-Expandable Intracranial Stent for Acute Stroke Treatment
Stroke, March 1, 2009; 40(3): 847 - 852.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
B. P. Soares, J. D. Chien, and M. Wintermark
MR and CT Monitoring of Recanalization, Reperfusion, and Penumbra Salvage: Everything That Recanalizes Does Not Necessarily Reperfuse!
Stroke, March 1, 2009; 40(3_suppl_1): S24 - S27.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
J. P. Broderick
Endovascular Therapy for Acute Ischemic Stroke
Stroke, March 1, 2009; 40(3_suppl_1): S103 - S106.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
R. G. Nogueira, W. S. Smith, and on Behalf of the MERCI and Multi MERCI Writing Com
Safety and Efficacy of Endovascular Thrombectomy in Patients With Abnormal Hemostasis: Pooled Analysis of the MERCI and Multi MERCI Trials
Stroke, February 1, 2009; 40(2): 516 - 522.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
P.T.L. Chiam, R.M. Samuelson, J. Mocco, R.A. Hanel, A.H. Siddiqui, L.N. Hopkins, and E.I. Levy
Navigability Trumps All: Stenting of Acute Middle Cerebral Artery Occlusions with a New Self-Expandable Stent
AJNR Am. J. Neuroradiol., November 1, 2008; 29(10): 1956 - 1958.
[Abstract] [Full Text] [PDF]