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(Stroke. 2007;38:1274.)
© 2007 American Heart Association, Inc.

Original Contributions

Mechanical Thrombectomy of Intracranial Internal Carotid Occlusion

Pooled Results of the MERCI and Multi MERCI Part I Trials

Alexander C. Flint, MD, PhD; Gary R. Duckwiler, MD; Ronald F. Budzik, MD; David S. Liebeskind, MD; Wade S. Smith, MD, PhD for the MERCI and Multi MERCI Writing Committee

From the Department of Neurology (A.C.F., W.S.S.), University of California, San Francisco, San Francisco, Calif.; the Departments of Radiology (G.R.D.) and Neurology (D.S.L.), University of California, Los Angeles, Los Angeles, Calif.; and the Department of Radiology (R.F.B.), Riverside Methodist Hospital, Columbus, Ohio.

Correspondence to Alexander C. Flint, MD, PhD, University of California, San Francisco, Neurovascular Service and Neurocritical Care, 505 Parnassus Ave, San Francisco CA 94143-0114. E-mail alex.flint{at}ucsfmedctr.org

Background and Purpose— Acute stroke from occlusion of the intracranial internal carotid artery (ICA) generally has a poor prognosis and appears to respond poorly to intravenous thrombolysis. Mechanical thrombectomy is a newly available modality for acute stroke therapy, but it is unknown whether this endovascular therapy may have a role in the specific setting of intracranial ICA occlusion. We therefore assessed the success rate of the Merci Retriever mechanical thrombectomy device in recanalization of intracranial ICA occlusions and sought to determine whether ICA recanalization with this therapy can result in better outcomes.

Methods— All patients with acute stroke from intracranial ICA occlusion were identified in the MERCI and Multi MERCI Part I trials. We determined the success rate of ICA recanalization with endovascular thrombectomy and then assessed clinical outcomes according to whether vessel recanalization was successful.

Results— Eighty patients with acute stroke from intracranial ICA occlusion were identified. Of these 80 patients, 53% had successful ICA recanalization with the Merci Retriever alone and 63% had ICA recanalization with use of the Merci Retriever plus adjunctive endovascular treatment. Baseline patient characteristics and procedural complications did not differ between the recanalized and nonrecanalized groups. Good clinical outcome, defined by a modified Rankin Scale of 0 to 2 at 90 days, occurred in 39% of patients with ICA recanalization (n=19 of 49) and in 3% of patients without ICA recanalization (n=1 of 30) (P<0.001; one patient was lost to follow up for 90-day modified Rankin Scale). Ninety-day mortality was 30% (n=15 of 50) in the recanalized group and 73% (n=22 of 30) in the nonrecanalized group (P<0.001). Symptomatic hemorrhage was not significantly different between the recanalized (6% [n=3 of 50]) and nonrecanalized (16.7% [n=5 of 30]) groups (P=0.14). Hemorrhage rates were also not found to be influenced by use of intravenous thrombolysis before mechanical thrombectomy. Multivariable logistic regression identified ICA recanalization (OR=28.4, 95% CI=2.6 to >99.9) and lack of history of hypertension (OR=0.15, 95% CI=0.04 to 0.57) as significant predictors of a good 90-day outcome. Failure to recanalize the ICA (OR=0.16, 95% CI=0.05 to 0.51) and age (per decade, OR=1.07, 95% CI=1.03 to 1.13) were significant predictors of mortality at 90 days.

Conclusions— Mechanical thrombectomy of acute intracranial ICA occlusion using the Merci Retriever device, alone or in combination with adjunctive endovascular therapy, has a high rate of successful vessel recanalization. Subjects with successful ICA recanalization by this method have improved poststroke clinical outcome and survival compared with subjects in which the ICA is not successfully recanalized.

Key Words: acute stroke • endovascular treatment • internal carotid artery • thrombectomy

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