Abstract WMP7: Clinical, Angiographic, and Radiographic Outcomes Differences Amongst Mechanical Thrombectomy Devices: Initial Experience of a Large-Volume Center
Background and Purpose: Early reperfusion is the keystone in (AIS) therapy. Here, we compare the angiographic, radiographic, and clinical outcomes amongst the three device categories currently available.
Methods: Retrospective review of a prospective collected database of large vessel AIS in a large academic center. Data from all consecutive patients who underwent clot retrieval using Merci, Penumbra, or Stent-Retrievers (Solitaire, n=31 or Trevo, n=20) from September 2010 to July 2012 were analyzed. Baseline characteristics were compared across the 3 groups. The outcome measures included the rates of recanalization (TICI 2b-3), symptomatic intracebral hemorrhage (sICH, defined as any parenchymal hematoma e.g. PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale, mRS 0-2) at 90 days.
Results: The entire cohort included 242 patients with a mean age of 65.5 and median baseline NIHSS 20. The median ASPECTS score was 8. There were no significant differences in terms of baseline characteristics amongst the 3 device groups. No differences in the rate of sICH (5.9% vs. 6.02% vs. 7.41%, for Stent retrieval, Penumbra and Merci respectively, P= 0.91), mean procedure time (90.6, 76.23 and 75.3 min for Stent retrieval, Penumbra and Merci respectively, P= 0.05), and the volume of infarction (70.4, 58.02, and 65.61 cc for Stent retrieval, Penumbra and Merci respectively, P = 0.47) between the Stent-Retriever, Penumbra, and Merci groups, respectively. However, the rates of reperfusion (88.2 % vs. 77.1% vs. 69.1 %, p= 0.041) and 90-day functional independence (54.9 % vs. 43.4 % vs. 24.7%, p=0.0015) were significantly higher with Stent-Retrievers as compared to Penumbra or Merci treatments. There was no significant difference in the rate of 90-day mortality amongst the different devices (33.33%, 26.51% and 40.74% for Stent-Retriever, Penumbra, and Merci groups, respectively, P= 0.1549).
Conclusion: Our initial data suggest a potential superiority of the Stent-Retriever technology to both Penumbra and Merci devices. Differences between Stent-Retrievers and Penumbra were much smaller in our experience and additional comparison in a randomized prospective fashion is warranted.
- © 2012 by American Heart Association, Inc.