BACKGROUND AND PURPOSE: Intracranial mechanical thrombectomy is a therapeutic option for acute ischemic stroke patients failing intravenous tissue plasminogen activator (IV tPA). We compared patients treated by mechanical embolus removal in cerebral ischemia (MERCI) thrombectomy after failed IV tPA with those treated with thrombectomy alone. METHODS: We pooled MERCI and Multi MERCI study patients, grouped them either as failed IV tPA or non-IV tPA, and assessed revascularization rates, procedural complications, symptomatic hemorrhage rates, clinical outcomes, and mortality. We also evaluated outcomes stratified by the occlusion site and final revascularization. RESULTS: Among 305 patients, 48 failed, and 257 were ineligible for IV tPA. Nonresponders to IV tPA trended toward a higher revascularization rate (73% versus 63%) and less mortality (27.7% versus 40.1%) and had similar rates of symptomatic hemorrhage and procedural complications. Favorable 90-day outcomes were similar in failed and non-IV tPA patients (38% versus 31%), with no difference according to occlusion site. Among patients failing IV tPA, good outcomes tended to occur more frequently in revascularized patients (47.1% versus 15.4%), although this relationship was attributable solely to middle cerebral artery and not internal carotid artery occlusions, with no difference in mortality. Among IV tPA-ineligible patients, revascularization correlated with good outcome (47.4% versus 4.4%) and less mortality (28.5% versus 59.6%). CONCLUSIONS: The risks of hemorrhage and procedure-related complications after mechanical thrombectomy do not differ with respect to previous IV tPA administration. Thrombectomy after IV tPA achieves similar rates of good outcomes, a tendency toward lower mortality, and similar revascularization rates when stratified by clot location. Good outcomes correlate with successful revascularization except with internal carotid artery occlusions in tPA-nonresponders.
BACKGROUND AND PURPOSE: Intracranial mechanical thrombectomy is a therapeutic option for acute ischemic strokepatients failing intravenous tissue plasminogen activator (IV tPA). We compared patients treated by mechanical embolus removal in cerebral ischemia (MERCI) thrombectomy after failed IV tPA with those treated with thrombectomy alone. METHODS: We pooled MERCI and Multi MERCI study patients, grouped them either as failed IV tPA or non-IV tPA, and assessed revascularization rates, procedural complications, symptomatic hemorrhage rates, clinical outcomes, and mortality. We also evaluated outcomes stratified by the occlusion site and final revascularization. RESULTS: Among 305 patients, 48 failed, and 257 were ineligible for IV tPA. Nonresponders to IV tPA trended toward a higher revascularization rate (73% versus 63%) and less mortality (27.7% versus 40.1%) and had similar rates of symptomatic hemorrhage and procedural complications. Favorable 90-day outcomes were similar in failed and non-IV tPApatients (38% versus 31%), with no difference according to occlusion site. Among patients failing IV tPA, good outcomes tended to occur more frequently in revascularized patients (47.1% versus 15.4%), although this relationship was attributable solely to middle cerebral artery and not internal carotid artery occlusions, with no difference in mortality. Among IV tPA-ineligible patients, revascularization correlated with good outcome (47.4% versus 4.4%) and less mortality (28.5% versus 59.6%). CONCLUSIONS: The risks of hemorrhage and procedure-related complications after mechanical thrombectomy do not differ with respect to previous IV tPA administration. Thrombectomy after IV tPA achieves similar rates of good outcomes, a tendency toward lower mortality, and similar revascularization rates when stratified by clot location. Good outcomes correlate with successful revascularization except with internal carotid artery occlusions in tPA-nonresponders.
Authors: Oliver Herrmann; Andreas Hug; Julian Bösel; Juliana Johanna Petersen; Marius Hartmann; Stefan Rohde; Martin Bendszus; Peter Arthur Ringleb; Werner Hacke; Roland Veltkamp Journal: Neurocrit Care Date: 2012-12 Impact factor: 3.210
Authors: Jens Fiehler; Michael Söderman; Francis Turjman; Philip M White; Søren Jacob Bakke; Salvatore Mangiafico; Rüdiger von Kummer; Mario Muto; Christophe Cognard; Jan Gralla Journal: Neuroradiology Date: 2012-09-05 Impact factor: 2.804
Authors: Adnan I Qureshi; Foad Abd-Allah; Aitziber Aleu; John J Connors; Ricardo A Hanel; Ameer E Hassan; Haitham M Hussein; Nazli A Janjua; Rakesh Khatri; Jawad F Kirmani; Mikael Mazighi; Heinrich P Mattle; Jefferson T Miley; Thanh N Nguyen; Gustavo J Rodriguez; Qaisar A Shah; Adnan H Siddiqui; Jose I Suarez; M Fareed K Suri; Reha Tolun Journal: J Vasc Interv Neurol Date: 2014-05
Authors: J-F Vendrell; R Mernes; N Nagot; D Milhaud; K Lobotesis; V Costalat; P Machi; I L Maldonado; C Riquelme; C Arquizan; A Bonafe Journal: AJNR Am J Neuroradiol Date: 2012-08-09 Impact factor: 3.825
Authors: Zhong-Song Shi; Gary R Duckwiler; Yince Loh; David S Liebeskind; Nestor R Gonzalez; Satoshi Tateshima; Reza Jahan; Jeffrey L Saver; Fernando Viñuela Journal: CNS Neurosci Ther Date: 2012-08-20 Impact factor: 5.243
Authors: Jeffrey L Saver; Tudor G Jovin; Wade S Smith; Gregory W Albers; Jean-Claude Baron; Johannes Boltze; Joseph P Broderick; Lisa A Davis; Andrew M Demchuk; Salvatore DeSena; Jens Fiehler; Philip B Gorelick; Werner Hacke; Bill Holt; Reza Jahan; Hui Jing; Pooja Khatri; Chelsea S Kidwell; Kennedy R Lees; Michael H Lev; David S Liebeskind; Marie Luby; Patrick Lyden; J Thomas Megerian; J Mocco; Keith W Muir; Howard A Rowley; Richard M Ruedy; Sean I Savitz; Vitas J Sipelis; Samuel K Shimp; Lawrence R Wechsler; Max Wintermark; Ona Wu; Dileep R Yavagal; Albert J Yoo Journal: Stroke Date: 2013-11-05 Impact factor: 7.914