Key result
Merci mechanical thrombectomy yields favorable 90-day functional outcomes in ~32% of acute stroke patients.
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Background: Mechanical thrombectomy is a promising adjuvant or stand-alone therapy for acute ischemic stroke (AIS) caused by occlusion of a large vessel in patients beyond the systemic thrombolysis therapeutic window. This review focuses on the clinical and angiographic outcomes of mechanical thrombectomy with use of the Merci retriever device. Methods: Available literature published to date on the major trials and observational studies involving the Merci retriever was reviewed. In addition to the review, results from studies involving the Merci retriever were compared to results from Prolyse in Acute Cerebral Thromboembolism II (PROACT II) and the Penumbra device studies. The predictors for favorable outcome following revascularization with the Merci device were reviewed on the basis of published stratified analyses. Favorable clinical outcome was defined in the Merci experience by a modified Rankin Scale (mRS) score of ≤2 at 90 days following AIS. Results: Presented in this review are a total of 1,226 patients treated with the Merci device; 305 patients are from 2 pivotal trials involving the device, and the remaining 921 patients are from observational studies in the Merci registry. The 90-day mRS of ≤2 was achieved in 32% of the patient group, with an overall mortality rate of 35.2%. Symptomatic intracerebral hemorrhage was identified in 7.3% of patients treated with Merci retriever, a result comparable to that in the PROACT II and Penumbra thrombectomy trials. Successful recanalization, lower NIH Stroke Scale score, and younger age were identified as the strongest predictors of favorable outcomes. Conclusion: Mechanical thrombectomy with the Merci retriever device is a safe treatment modality for AIS patients presenting with a large-vessel occlusion within 8 hours of symptom onset. Although the Merci retriever showed a good recanalization rate, there are currently no randomized clinical trials to assess its clinical efficacy in comparison with systemic thrombolysis within a window of 3 to 4.5 hours or with standard of care beyond a 4.5-hour window. AIS= : acute ischemic stroke; CI= : confidence interval; IA-tPA= : intra-arterial tissue plasminogen activator; ICH= : intracerebral hemorrhage; IV-tPA= : IV tissue plasminogen activator; MERCI= : Mechanical Embolus Removal in Cerebral Ischemia; mRS= : modified Rankin Scale; NIHSS= : NIH Stroke Scale; OR= : odds ratio; PROACT= : Prolyse in Acute Cerebral Thromboembolism; TICI= : thrombolysis in cerebral infarction; TIMI= : thrombolysis in myocardial infarction
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Alshekhlee et al. (2012) conducted a review in Acute ischemic stroke with large-vessel occlusion (n=1,226). Mechanical thrombectomy with the Merci retriever device vs. PROACT II and Penumbra device studies was evaluated on Favorable clinical outcome defined as modified Rankin Scale (mRS) score ≤2 at 90 days. Mechanical thrombectomy with the Merci retriever achieved a 90-day mRS ≤2 in 32% of acute ischemic stroke patients, with 35.2% mortality and 7.3% symptomatic intracerebral hemorrhage.
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