Published online before print April 6, 2006, doi: 10.1161/01.STR.0000217361.50952.5c
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(Stroke. 2006;37:1341.)
© 2006 American Heart Association, Inc.
Controversies in Stroke |
Does the Merci Retriever Work?
Against
From the University of Pittsburgh Medical Center Stroke Institute, Pittsburgh, Pa.
Correspondence to Lawrence R. Wechsler, MD, UPMC Stroke Institute, C426 PUH, 200 Lothrop St, Pittsburgh, PA 15213. E-mail lwechsler@stroke.upmc.edu
Key Words: acute stroke
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
In a decade after approval of IV rt-PA for acute stroke, treatment leads to good outcomes in less than half of patients, and hemorrhage rates have not been reduced. Recanalization improves outcome1 but is often delayed and incomplete. Devices offer the promise of rapid recanalization with a greater proportion of good outcomes and fewer hemorrhages. The Merci retrieval system was introduced with hopes of fulfilling this promise. The FDA recently approved this device for removal of thrombus from intracranial arteries in patients with stroke. Despite this approval, the question of whether the device works remains unsettled.
The recently published Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial2 using the Merci retriever claims efficacy based on a recanalization rate that is greater than the spontaneous recanalization rate observed in the Prolyse in Acute Cerebral Thromboembolism (PROACT) II trial control group.3 Recanalization may result in a variety of outcomes depending on timing, depth and duration of ischemia.4 These include improvement, no clinical change, reperfusion hemorrhage or massive cerebral edema resulting in neurological worsening or death. Thus, the most important measure of efficacy for any acute stroke treatment is not recanalization, but clinical outcome. On this score, evidence that the Merci Retriever works is lacking. In the MERCI trial, only 28% of patients reached a mRS score of 
2 at 90 days. This is only slightly greater than the 25% of control patients reaching this outcome in the PROACT II study and does not compare favorably with the 40% of patients achieving mRS
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Stroke 2006 37: 1343-1344.
Stroke 2006 37: 1340-1341.
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