title: Mechanical thrombectomy devices for endovascular management of acute ischemic stroke: Duke stroke center experience.
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.
  
  
  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.
authors.affiliation: Department of Radiology and Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Agrawal
authors.forename: David
authors.initials: D
authors.lastname: Golovoy
authors.forename: Shahid
authors.initials: S
authors.lastname: Nimjee
authors.forename: Andrew
authors.initials: A
authors.lastname: Ferrell
authors.forename: Tony
authors.initials: T
authors.lastname: Smith
authors.forename: Gavin
authors.initials: G
authors.lastname: Britz
keywords: Acute ischemic stroke; large vessel occlusion; mechanical thrombectomy; merci; penumbra; solitaire-FR; stroke intervention
references.citation: AJNR Am J Neuroradiol. 2011 Aug;32(7):1245-8
references.pmid: 21596812
references.citation: Stroke. 2008 Apr;39(4):1205-12
references.pmid: 18309168
references.citation: Lancet. 2007 Jan 27;369(9558):275-82
references.pmid: 17258667
references.citation: Stroke. 2001 Mar;32(3):661-8
references.pmid: 11239184
references.citation: Neurosurgery. 2011 Oct;69(4):915-20; discussion 920
references.pmid: 21552168
references.citation: AJNR Am J Neuroradiol. 2010 Apr;31(4):628-33
references.pmid: 20019113
references.citation: Lancet. 2012 Oct 6;380(9849):1241-9
references.pmid: 22932715
references.citation: Cardiovasc Intervent Radiol. 2013 Apr;36(2):338-45
references.pmid: 22806246
references.citation: Interv Neuroradiol. 2011 Jun;17(2):235-40
references.pmid: 21696665
references.citation: Stroke. 2009 Nov;40(11):3552-6
references.pmid: 19696415
references.citation: AJNR Am J Neuroradiol. 2006 Jun-Jul;27(6):1177-82
references.pmid: 16775259
references.citation: N Engl J Med. 2008 Sep 25;359(13):1317-29
references.pmid: 18815396
references.citation: J Clin Neurosci. 2012 Jan;19(1):39-43
references.pmid: 22136733
references.citation: Stroke. 1997 Nov;28(11):2109-18
references.pmid: 9368550
references.citation: J Neurointerv Surg. 2013 May;5 Suppl 1:i25-32
references.pmid: 22434904
references.citation: World Neurosurg. 2011 Dec;76(6 Suppl):S16-23
references.pmid: 22182267
references.citation: Neurology. 2002 Sep 24;59(6):862-7
references.pmid: 12297567
references.citation: Stroke. 2005 Jul;36(7):1432-8
references.pmid: 15961709
references.citation: Stroke. 2010 Nov;41(11):2559-67
references.pmid: 20947848
references.citation: Neurosurg Focus. 2011 Jun;30(6):E10
references.pmid: 21631211
references.citation: Stroke. 1998 Jan;29(1):4-11
references.pmid: 9445320
references.citation: Cerebrovasc Dis. 2012;34(1):70-7
references.pmid: 22759754
references.citation: Stroke. 2009 Aug;40(8):2761-8
references.pmid: 19590057
references.citation: Nervenarzt. 2008 Oct;79(10):1180-4, 1186-8, 1190-201
references.pmid: 18651119
references.citation: Curr Treat Options Cardiovasc Med. 2012 Jun;14(3):260-72
references.pmid: 22392611
references.citation: AJNR Am J Neuroradiol. 2013 Jan;34(1):153-8
references.pmid: 22837308