Impact of Merci device fracture on clinical outcome of acute ischemic stroke after mechanical thrombectomy.
OBJECTIVE
To investigate the frequency and predictors of Merci device fracture in patients with acute ischemic stroke treated with mechanical thrombectomy and its impact on clinical outcome.


METHODS
We retrospectively analyzed patients with acute ischemic stroke treated by thrombectomy with the Merci Retriever and identified the presence of device fracture. The predictors of device fracture were assessed. We evaluated the impact of device fracture on hemorrhage and clinical outcome.


RESULTS
Of 136 patients treated by thrombectomy, 6 (4.4%) experienced intraprocedural Merci device fracture. Internal carotid artery occlusion was associated with device fracture. The fractured X and L series Merci Retrievers were successfully ensnared in four patients. Patients with fractured devices had similar rates of successful revascularization with those without. In patients with fractured devices, no parenchymal hematomas were found, while hemorrhagic infarction and subarachnoid hemorrhage were found in three and two patients, respectively. Patients with fractured devices tended to be more dependent (modified Rankin Scale ≥ 3) at discharge, but had similar rates of in-hospital mortality.


CONCLUSIONS
Merci device fracture is relatively infrequent in patients with acute ischemic stroke treated with thrombectomy. This complication may not increase the risk of parenchymal hematoma but tends to be associated with poor outcome.
Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. zhongsongshi@gmail.com
Zhong-Song
ZS
Shi
Gary R
GR
Duckwiler
Yince
Y
Loh
David S
DS
Liebeskind
Nestor R
NR
Gonzalez
Satoshi
S
Tateshima
Reza
R
Jahan
Jeffrey L
JL
Saver
Fernando
F
Viñuela
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects* / Q000295:instrumentation*; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000601:surgery*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator