Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience
Background: Mechanical thrombectomy devices are gaining popularity in large vessel occlusions where chemical thrombolysis is usually futile. MERCI, Multi-MERCI, Penumbra and SWIFT trails have elevated the status of mechanical thrombectomy from being a complementary treatment modality to mainstream s...
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Veröffentlicht in: | Asian journal of neurosurgery 2012-10, Vol.7 (4), p.166-170 |
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description | Background:
Mechanical thrombectomy devices are gaining popularity in large vessel occlusions where chemical thrombolysis is usually futile. MERCI, Multi-MERCI, Penumbra and SWIFT trails have elevated the status of mechanical thrombectomy from being a complementary treatment modality to mainstream stroke intervention. The aim of this study was to compare our immediate recanalization rates with available mechanical devices.
Materials and Methods:
A retrospective review from March 2009 to August 2012 was performed on patients who underwent mechanical thrombectomy for large vessel occlusion. Cases where IATPA and/or balloon angioplasty was performed without mechanical thrombectomy were excluded from the study. Recanalization rates were assessed immediately post-procedure by follow-up angiography. TICI scores were used to quantify the extent of recanalization and the residual clot burden.
Results:
Twenty two procedures were performed on 20 patients using Merci (MER):5; Penumbra (PEN):11; Solitaire-FR (SOL):6. Two patients underwent intervention using both Merci and Penumbra devices. The M:F ratio was 1.2:1. The most common vascular territory involved was the right MCA (9/20) followed by left MCA (5/20), left ICA (2/20), basilar (3/20) and vertebral arteries (1/20). The average door to needle time was 210 minutes [MER: 184.4; PEN: 249.2; SOL: 162]. Additional procedures were performed in 63.4% (14/22) of the patients [MER: 80% (4/5); PEN: 72.7% (8/11) and SOL: 33.3% (2/6)]. Vasospasm was observed in MER: 20% (1/5); PEN: 9.1% (1/11); SOL: 0% (0/6)]. Complete recanalization was achieved in 59.1% (13/22) [MER: 40% (2/5); PEN: 45.5% (5/11); SOL: 100% (6/6)]. The rate of complete recanalization was statistically significant for the Solitaire group vs. the MERCI group ( P=0.0062) as well as the Penumbra group (0.0025). The average pre-procedure TICI was 0.4 [MER: 0.6; PEN: 0.3; SOL: 0.3], while the average post-procedure TICI was 2.5 [MER: 2.4; PEN: 2.3; SOL: 3.0].
Conclusions:
The study reveals a higher rate of angiographic recanalization using the Solitaire-FR device, requiring a lesser number of passes and other associated procedures as compared to MERCI and Penumbra. Thus, Stentrievers (Solitaire-FR) are advantageous in faster device delivery and quick flow restoration. However, future prospective randomized large trials are required to confirm these early results. |
doi_str_mv | 10.4103/1793-5482.106647 |
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fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3613637</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A322950187</galeid><sourcerecordid>A322950187</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438c-ae098d31e7208baca5f451b79d071cf98c0237e4fc5e0449715fd6d17e634efa3</originalsourceid><addsrcrecordid>eNp1kkuP0zAURiMEYqph9qxQJCTEJh0_82CBNAxPaRAbWFuuc9146tjFTlrm3-MonaqVIF5Ets89ura_LHuJ0ZJhRK9x1dCCs5osMSpLVj3JFoSwumhKzJ5mi-P2RXYV4z1KH8ecI_I8uyCU86apySKL30F10hklbT50wfcrUIPvH_IWdkZBzLUPObjW72RUo5Uh76WTa-jBDbnXuVTjALmJqoPeqDwOwW_gXf5x3MBhkquEQpL82UIw4BS8yJ5paSNcHf6X2a_Pn37efi3ufnz5dntzVyhGa1VIQE3dUgwVQfVKKsk143hVNS2qsNJNrRChFTCtOCDGmgpz3ZYtrqCkDLSkl9n72bsdVz20Ux9BWrENppfhQXhpxPmOM51Y-52gJaYlrZLg7UEQ_O8R4iD6dFKwVjrwYxSYktRpw2uc0NczupYWhHHaJ6OacHFDCWk4wvUkXP6DSqOdbs870CatnxW8OSnoQNqhi96Og_EunoNoBlXwMQbQx2NiJKa4iCkPYsqDmOOSSl6dXs-x4DEcCfgwA3tv0wvGjR33EERiN87vz8TFiVjgshSPsUqS61kydCalRtz7Mbj06v_v6y-AQN68</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1324389581</pqid></control><display><type>article</type><title>Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience</title><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>PubMed Central Open Access</source><source>Thieme Connect Journals Open Access</source><creator>Agrawal, Abhishek ; Golovoy, David ; Nimjee, Shahid ; Ferrell, Andrew ; Smith, Tony ; Britz, Gavin</creator><creatorcontrib>Agrawal, Abhishek ; Golovoy, David ; Nimjee, Shahid ; Ferrell, Andrew ; Smith, Tony ; Britz, Gavin</creatorcontrib><description>Background:
Mechanical thrombectomy devices are gaining popularity in large vessel occlusions where chemical thrombolysis is usually futile. MERCI, Multi-MERCI, Penumbra and SWIFT trails have elevated the status of mechanical thrombectomy from being a complementary treatment modality to mainstream stroke intervention. The aim of this study was to compare our immediate recanalization rates with available mechanical devices.
Materials and Methods:
A retrospective review from March 2009 to August 2012 was performed on patients who underwent mechanical thrombectomy for large vessel occlusion. Cases where IATPA and/or balloon angioplasty was performed without mechanical thrombectomy were excluded from the study. Recanalization rates were assessed immediately post-procedure by follow-up angiography. TICI scores were used to quantify the extent of recanalization and the residual clot burden.
Results:
Twenty two procedures were performed on 20 patients using Merci (MER):5; Penumbra (PEN):11; Solitaire-FR (SOL):6. Two patients underwent intervention using both Merci and Penumbra devices. The M:F ratio was 1.2:1. The most common vascular territory involved was the right MCA (9/20) followed by left MCA (5/20), left ICA (2/20), basilar (3/20) and vertebral arteries (1/20). The average door to needle time was 210 minutes [MER: 184.4; PEN: 249.2; SOL: 162]. Additional procedures were performed in 63.4% (14/22) of the patients [MER: 80% (4/5); PEN: 72.7% (8/11) and SOL: 33.3% (2/6)]. Vasospasm was observed in MER: 20% (1/5); PEN: 9.1% (1/11); SOL: 0% (0/6)]. Complete recanalization was achieved in 59.1% (13/22) [MER: 40% (2/5); PEN: 45.5% (5/11); SOL: 100% (6/6)]. The rate of complete recanalization was statistically significant for the Solitaire group vs. the MERCI group ( P=0.0062) as well as the Penumbra group (0.0025). The average pre-procedure TICI was 0.4 [MER: 0.6; PEN: 0.3; SOL: 0.3], while the average post-procedure TICI was 2.5 [MER: 2.4; PEN: 2.3; SOL: 3.0].
Conclusions:
The study reveals a higher rate of angiographic recanalization using the Solitaire-FR device, requiring a lesser number of passes and other associated procedures as compared to MERCI and Penumbra. Thus, Stentrievers (Solitaire-FR) are advantageous in faster device delivery and quick flow restoration. However, future prospective randomized large trials are required to confirm these early results.</description><identifier>ISSN: 1793-5482</identifier><identifier>EISSN: 2248-9614</identifier><identifier>DOI: 10.4103/1793-5482.106647</identifier><identifier>PMID: 23559982</identifier><language>eng</language><publisher>A-12, 2nd Floor, Sector 2, Noida-201301 UP, India: Thieme Medical and Scientific Publishers Pvt. Ltd</publisher><subject>Care and treatment ; Diagnosis ; Embolism ; Original ; ORIGINAL ARTICLE ; Patient outcomes ; Stroke (Disease) ; Surgery</subject><ispartof>Asian journal of neurosurgery, 2012-10, Vol.7 (4), p.166-170</ispartof><rights>Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon.</rights><rights>COPYRIGHT 2012 Medknow Publications and Media Pvt. Ltd.</rights><rights>Copyright: © Asian Journal of Neurosurgery 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438c-ae098d31e7208baca5f451b79d071cf98c0237e4fc5e0449715fd6d17e634efa3</citedby><cites>FETCH-LOGICAL-c438c-ae098d31e7208baca5f451b79d071cf98c0237e4fc5e0449715fd6d17e634efa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613637/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613637/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,20870,27901,27902,53766,53768,54562</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23559982$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Agrawal, Abhishek</creatorcontrib><creatorcontrib>Golovoy, David</creatorcontrib><creatorcontrib>Nimjee, Shahid</creatorcontrib><creatorcontrib>Ferrell, Andrew</creatorcontrib><creatorcontrib>Smith, Tony</creatorcontrib><creatorcontrib>Britz, Gavin</creatorcontrib><title>Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience</title><title>Asian journal of neurosurgery</title><addtitle>Asian J Neurosurg</addtitle><description>Background:
Mechanical thrombectomy devices are gaining popularity in large vessel occlusions where chemical thrombolysis is usually futile. MERCI, Multi-MERCI, Penumbra and SWIFT trails have elevated the status of mechanical thrombectomy from being a complementary treatment modality to mainstream stroke intervention. The aim of this study was to compare our immediate recanalization rates with available mechanical devices.
Materials and Methods:
A retrospective review from March 2009 to August 2012 was performed on patients who underwent mechanical thrombectomy for large vessel occlusion. Cases where IATPA and/or balloon angioplasty was performed without mechanical thrombectomy were excluded from the study. Recanalization rates were assessed immediately post-procedure by follow-up angiography. TICI scores were used to quantify the extent of recanalization and the residual clot burden.
Results:
Twenty two procedures were performed on 20 patients using Merci (MER):5; Penumbra (PEN):11; Solitaire-FR (SOL):6. Two patients underwent intervention using both Merci and Penumbra devices. The M:F ratio was 1.2:1. The most common vascular territory involved was the right MCA (9/20) followed by left MCA (5/20), left ICA (2/20), basilar (3/20) and vertebral arteries (1/20). The average door to needle time was 210 minutes [MER: 184.4; PEN: 249.2; SOL: 162]. Additional procedures were performed in 63.4% (14/22) of the patients [MER: 80% (4/5); PEN: 72.7% (8/11) and SOL: 33.3% (2/6)]. Vasospasm was observed in MER: 20% (1/5); PEN: 9.1% (1/11); SOL: 0% (0/6)]. Complete recanalization was achieved in 59.1% (13/22) [MER: 40% (2/5); PEN: 45.5% (5/11); SOL: 100% (6/6)]. The rate of complete recanalization was statistically significant for the Solitaire group vs. the MERCI group ( P=0.0062) as well as the Penumbra group (0.0025). The average pre-procedure TICI was 0.4 [MER: 0.6; PEN: 0.3; SOL: 0.3], while the average post-procedure TICI was 2.5 [MER: 2.4; PEN: 2.3; SOL: 3.0].
Conclusions:
The study reveals a higher rate of angiographic recanalization using the Solitaire-FR device, requiring a lesser number of passes and other associated procedures as compared to MERCI and Penumbra. Thus, Stentrievers (Solitaire-FR) are advantageous in faster device delivery and quick flow restoration. However, future prospective randomized large trials are required to confirm these early results.</description><subject>Care and treatment</subject><subject>Diagnosis</subject><subject>Embolism</subject><subject>Original</subject><subject>ORIGINAL ARTICLE</subject><subject>Patient outcomes</subject><subject>Stroke (Disease)</subject><subject>Surgery</subject><issn>1793-5482</issn><issn>2248-9614</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>0U6</sourceid><recordid>eNp1kkuP0zAURiMEYqph9qxQJCTEJh0_82CBNAxPaRAbWFuuc9146tjFTlrm3-MonaqVIF5Ets89ura_LHuJ0ZJhRK9x1dCCs5osMSpLVj3JFoSwumhKzJ5mi-P2RXYV4z1KH8ecI_I8uyCU86apySKL30F10hklbT50wfcrUIPvH_IWdkZBzLUPObjW72RUo5Uh76WTa-jBDbnXuVTjALmJqoPeqDwOwW_gXf5x3MBhkquEQpL82UIw4BS8yJ5paSNcHf6X2a_Pn37efi3ufnz5dntzVyhGa1VIQE3dUgwVQfVKKsk143hVNS2qsNJNrRChFTCtOCDGmgpz3ZYtrqCkDLSkl9n72bsdVz20Ux9BWrENppfhQXhpxPmOM51Y-52gJaYlrZLg7UEQ_O8R4iD6dFKwVjrwYxSYktRpw2uc0NczupYWhHHaJ6OacHFDCWk4wvUkXP6DSqOdbs870CatnxW8OSnoQNqhi96Og_EunoNoBlXwMQbQx2NiJKa4iCkPYsqDmOOSSl6dXs-x4DEcCfgwA3tv0wvGjR33EERiN87vz8TFiVjgshSPsUqS61kydCalRtz7Mbj06v_v6y-AQN68</recordid><startdate>20121001</startdate><enddate>20121001</enddate><creator>Agrawal, Abhishek</creator><creator>Golovoy, David</creator><creator>Nimjee, Shahid</creator><creator>Ferrell, Andrew</creator><creator>Smith, Tony</creator><creator>Britz, Gavin</creator><general>Thieme Medical and Scientific Publishers Pvt. Ltd</general><general>Annals of Cardiac Anaesthesia</general><general>Medknow Publications and Media Pvt. Ltd</general><general>Medknow Publications & Media Pvt Ltd</general><scope>0U6</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20121001</creationdate><title>Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience</title><author>Agrawal, Abhishek ; Golovoy, David ; Nimjee, Shahid ; Ferrell, Andrew ; Smith, Tony ; Britz, Gavin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438c-ae098d31e7208baca5f451b79d071cf98c0237e4fc5e0449715fd6d17e634efa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Care and treatment</topic><topic>Diagnosis</topic><topic>Embolism</topic><topic>Original</topic><topic>ORIGINAL ARTICLE</topic><topic>Patient outcomes</topic><topic>Stroke (Disease)</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Agrawal, Abhishek</creatorcontrib><creatorcontrib>Golovoy, David</creatorcontrib><creatorcontrib>Nimjee, Shahid</creatorcontrib><creatorcontrib>Ferrell, Andrew</creatorcontrib><creatorcontrib>Smith, Tony</creatorcontrib><creatorcontrib>Britz, Gavin</creatorcontrib><collection>Thieme Connect Journals Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Asian journal of neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Agrawal, Abhishek</au><au>Golovoy, David</au><au>Nimjee, Shahid</au><au>Ferrell, Andrew</au><au>Smith, Tony</au><au>Britz, Gavin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience</atitle><jtitle>Asian journal of neurosurgery</jtitle><addtitle>Asian J Neurosurg</addtitle><date>2012-10-01</date><risdate>2012</risdate><volume>7</volume><issue>4</issue><spage>166</spage><epage>170</epage><pages>166-170</pages><issn>1793-5482</issn><eissn>2248-9614</eissn><abstract>Background:
Mechanical thrombectomy devices are gaining popularity in large vessel occlusions where chemical thrombolysis is usually futile. MERCI, Multi-MERCI, Penumbra and SWIFT trails have elevated the status of mechanical thrombectomy from being a complementary treatment modality to mainstream stroke intervention. The aim of this study was to compare our immediate recanalization rates with available mechanical devices.
Materials and Methods:
A retrospective review from March 2009 to August 2012 was performed on patients who underwent mechanical thrombectomy for large vessel occlusion. Cases where IATPA and/or balloon angioplasty was performed without mechanical thrombectomy were excluded from the study. Recanalization rates were assessed immediately post-procedure by follow-up angiography. TICI scores were used to quantify the extent of recanalization and the residual clot burden.
Results:
Twenty two procedures were performed on 20 patients using Merci (MER):5; Penumbra (PEN):11; Solitaire-FR (SOL):6. Two patients underwent intervention using both Merci and Penumbra devices. The M:F ratio was 1.2:1. The most common vascular territory involved was the right MCA (9/20) followed by left MCA (5/20), left ICA (2/20), basilar (3/20) and vertebral arteries (1/20). The average door to needle time was 210 minutes [MER: 184.4; PEN: 249.2; SOL: 162]. Additional procedures were performed in 63.4% (14/22) of the patients [MER: 80% (4/5); PEN: 72.7% (8/11) and SOL: 33.3% (2/6)]. Vasospasm was observed in MER: 20% (1/5); PEN: 9.1% (1/11); SOL: 0% (0/6)]. Complete recanalization was achieved in 59.1% (13/22) [MER: 40% (2/5); PEN: 45.5% (5/11); SOL: 100% (6/6)]. The rate of complete recanalization was statistically significant for the Solitaire group vs. the MERCI group ( P=0.0062) as well as the Penumbra group (0.0025). The average pre-procedure TICI was 0.4 [MER: 0.6; PEN: 0.3; SOL: 0.3], while the average post-procedure TICI was 2.5 [MER: 2.4; PEN: 2.3; SOL: 3.0].
Conclusions:
The study reveals a higher rate of angiographic recanalization using the Solitaire-FR device, requiring a lesser number of passes and other associated procedures as compared to MERCI and Penumbra. Thus, Stentrievers (Solitaire-FR) are advantageous in faster device delivery and quick flow restoration. However, future prospective randomized large trials are required to confirm these early results.</abstract><cop>A-12, 2nd Floor, Sector 2, Noida-201301 UP, India</cop><pub>Thieme Medical and Scientific Publishers Pvt. Ltd</pub><pmid>23559982</pmid><doi>10.4103/1793-5482.106647</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Care and treatment Diagnosis Embolism Original ORIGINAL ARTICLE Patient outcomes Stroke (Disease) Surgery |
title | Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience |
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