PT  - JOURNAL ARTICLE
AU  - Kim, D.
AU  - Jahan, R.
AU  - Starkman, S.
AU  - Abolian, A.
AU  - Kidwell, C.S.
AU  - Vinuela, F.
AU  - Duckwiler, G.R.
AU  - Ovbiagele, B.
AU  - Vespa, P.M.
AU  - Selco, S.
AU  - Rajajee, V.
AU  - Saver, J.L.
TI  - Endovascular Mechanical Clot Retrieval in a Broad Ischemic Stroke Cohort
DP  - 2006 Nov 01
TA  - American Journal of Neuroradiology
PG  - 2048--2052
VI  - 27
IP  - 10
4099  - http://www.ajnr.org/content/27/10/2048.short
4100  - http://www.ajnr.org/content/27/10/2048.full
SO  - Am. J. Neuroradiol.2006 Nov 01; 27
AB  - BACKGROUND AND PURPOSE: Our aim was to describe an expanded experience with endovascular mechanical embolectomy in a broad group of patients, including those not meeting entry criteria for the MERCI multicenter trials.METHODS: We performed an analysis of all patients with ischemic stroke treated with the Merci Clot Retrieval Device at a single academic center outside of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trials.RESULTS: Twenty-four patients were treated with the device. Nine were MERCI trial ineligible: 4 received intravenous (IV) tissue plasminogen activator (tPA), 1 received IV tPA and was younger than 18 years of age, and 4 had time-to-treatment of longer than 8 hours. Mean age was 64 years (range, 14–89 years; 42% women). Median National Institutes of Health Stroke Scale (NIHSS) score was 21 (range, 11–30). Median symptoms-to-procedure-start time was 303 minutes (range, 85–2385 minutes). Recanalization (Thrombolysis in Myocardial Infarction, 2–3) was achieved in 15/24 (63%). In device-only patients, recanalization occurred in 10/16. In patients who failed IV tPA undergoing rescue embolectomy, recanalization was achieved in 4/5. Three patients unresponsive to device therapy received rescue intra-arterial tPA/abciximab; recanalization was achieved in 2/3. Recanalization was achieved in 3/4 patients in whom treatment was started longer than 8 hours after symptom onset. Asymptomatic hemorrhage occurred in 38%; symptomatic hemorrhage, in 8%. Three device fractures occurred; none worsened clinical outcome. In-hospital mortality was 17%; 90-day mortality, 29%. Good 90-day functional outcome (modified Rankin Scale, ≤2) was achieved by 25% (6/24).CONCLUSIONS: Endovascular mechanical embolectomy is an effective means of achieving revascularization in patients with acute ischemic stroke, including patients with late treatment start and intravenous tPA failure. Device-based therapy achieved recanalization in nearly two thirds of patients and good clinical outcomes in one fourth, with symptomatic hemorrhage in less than one tenth.