Endovascular mechanical clot retrieval in a broad ischemic stroke cohort

Doojin Kim, R. Jahan, S. Starkman, A. Abolian, Stella Kidwell, F. Vinuela, G. R. Duckwiler, B. Ovbiagele, P. M. Vespa, S. Selco, V. Rajajee, J. L. Saver

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: Our aim was to describe an expanded experience with endovascular mechanical embolectomy in a broad group of patients, including those not meeting entry criteria for the MERCI multicenter trials. METHODS: We performed an analysis of all patients with ischemic stroke treated with the Merci Clot Retrieval Device at a single academic center outside of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trials. RESULTS: Twenty-four patients were treated with the device. Nine were MERCI trial ineligible: 4 received intravenous (IV) tissue plasminogen activator (tPA), 1 received IV tPA and was younger than 18 years of age, and 4 had time-to-treatment of longer than 8 hours. Mean age was 64 years (range, 14-89 years; 42% women). Median National Institutes of Health Stroke Scale (NIHSS) score was 21 (range, 11-30). Median symptoms-to-procedure-start time was 303 minutes (range, 85-2385 minutes). Recanalization (Thrombolysis in Myocardial Infarction, 2-3) was achieved in 15/24 (63%). In device-only patients, recanalization occurred in 10/16. In patients who failed IV tPA undergoing rescue embolectomy, recanalization was ach eved in 4/5. Three patients unresponsive to device therapy received rescue intra-arterial tPA/abciximab; recanalization was achieved in 2/3. Recanalization was achieved in 3/4 patients in whom treatment was started longer than 8 hours after symptom onset. Asymptomatic hemorrhage occurred in 38%; symptomatic hemorrhage, in 8%. Three device fractures occurred; none worsened clinical outcome. In-hospital mortality was 17%; 90-day mortality, 29%. Good 90-day functional outcome (modified Rankin Scale, ≤2) was achieved by 25% (6/24). CONCLUSIONS: Endovascular mechanical embolectomy is an effective means of achieving revascularization in patients with acute ischemic stroke, including patients with late treatment start and intravenous tPA failure. Device-based therapy achieved recanalization in nearly two thirds of patients and good clinical outcomes in one fourth, with symptomatic hemorrhage in less than one tenth.

Original languageEnglish (US)
Pages (from-to)2048-2052
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume27
Issue number10
StatePublished - Nov 2006
Externally publishedYes

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Stroke
Tissue Plasminogen Activator
Embolectomy
Equipment and Supplies
Embolism
Brain Ischemia
Hemorrhage
Therapeutics
National Institutes of Health (U.S.)
Hospital Mortality
Multicenter Studies
Myocardial Infarction
Mortality

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Kim, D., Jahan, R., Starkman, S., Abolian, A., Kidwell, S., Vinuela, F., ... Saver, J. L. (2006). Endovascular mechanical clot retrieval in a broad ischemic stroke cohort. American Journal of Neuroradiology, 27(10), 2048-2052.

Endovascular mechanical clot retrieval in a broad ischemic stroke cohort. / Kim, Doojin; Jahan, R.; Starkman, S.; Abolian, A.; Kidwell, Stella; Vinuela, F.; Duckwiler, G. R.; Ovbiagele, B.; Vespa, P. M.; Selco, S.; Rajajee, V.; Saver, J. L.

In: American Journal of Neuroradiology, Vol. 27, No. 10, 11.2006, p. 2048-2052.

Research output: Contribution to journalArticle

Kim, D, Jahan, R, Starkman, S, Abolian, A, Kidwell, S, Vinuela, F, Duckwiler, GR, Ovbiagele, B, Vespa, PM, Selco, S, Rajajee, V & Saver, JL 2006, 'Endovascular mechanical clot retrieval in a broad ischemic stroke cohort', American Journal of Neuroradiology, vol. 27, no. 10, pp. 2048-2052.
Kim D, Jahan R, Starkman S, Abolian A, Kidwell S, Vinuela F et al. Endovascular mechanical clot retrieval in a broad ischemic stroke cohort. American Journal of Neuroradiology. 2006 Nov;27(10):2048-2052.
Kim, Doojin ; Jahan, R. ; Starkman, S. ; Abolian, A. ; Kidwell, Stella ; Vinuela, F. ; Duckwiler, G. R. ; Ovbiagele, B. ; Vespa, P. M. ; Selco, S. ; Rajajee, V. ; Saver, J. L. / Endovascular mechanical clot retrieval in a broad ischemic stroke cohort. In: American Journal of Neuroradiology. 2006 ; Vol. 27, No. 10. pp. 2048-2052.
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abstract = "BACKGROUND AND PURPOSE: Our aim was to describe an expanded experience with endovascular mechanical embolectomy in a broad group of patients, including those not meeting entry criteria for the MERCI multicenter trials. METHODS: We performed an analysis of all patients with ischemic stroke treated with the Merci Clot Retrieval Device at a single academic center outside of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trials. RESULTS: Twenty-four patients were treated with the device. Nine were MERCI trial ineligible: 4 received intravenous (IV) tissue plasminogen activator (tPA), 1 received IV tPA and was younger than 18 years of age, and 4 had time-to-treatment of longer than 8 hours. Mean age was 64 years (range, 14-89 years; 42{\%} women). Median National Institutes of Health Stroke Scale (NIHSS) score was 21 (range, 11-30). Median symptoms-to-procedure-start time was 303 minutes (range, 85-2385 minutes). Recanalization (Thrombolysis in Myocardial Infarction, 2-3) was achieved in 15/24 (63{\%}). In device-only patients, recanalization occurred in 10/16. In patients who failed IV tPA undergoing rescue embolectomy, recanalization was ach eved in 4/5. Three patients unresponsive to device therapy received rescue intra-arterial tPA/abciximab; recanalization was achieved in 2/3. Recanalization was achieved in 3/4 patients in whom treatment was started longer than 8 hours after symptom onset. Asymptomatic hemorrhage occurred in 38{\%}; symptomatic hemorrhage, in 8{\%}. Three device fractures occurred; none worsened clinical outcome. In-hospital mortality was 17{\%}; 90-day mortality, 29{\%}. Good 90-day functional outcome (modified Rankin Scale, ≤2) was achieved by 25{\%} (6/24). CONCLUSIONS: Endovascular mechanical embolectomy is an effective means of achieving revascularization in patients with acute ischemic stroke, including patients with late treatment start and intravenous tPA failure. Device-based therapy achieved recanalization in nearly two thirds of patients and good clinical outcomes in one fourth, with symptomatic hemorrhage in less than one tenth.",
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T1 - Endovascular mechanical clot retrieval in a broad ischemic stroke cohort

AU - Kim, Doojin

AU - Jahan, R.

AU - Starkman, S.

AU - Abolian, A.

AU - Kidwell, Stella

AU - Vinuela, F.

AU - Duckwiler, G. R.

AU - Ovbiagele, B.

AU - Vespa, P. M.

AU - Selco, S.

AU - Rajajee, V.

AU - Saver, J. L.

PY - 2006/11

Y1 - 2006/11

N2 - BACKGROUND AND PURPOSE: Our aim was to describe an expanded experience with endovascular mechanical embolectomy in a broad group of patients, including those not meeting entry criteria for the MERCI multicenter trials. METHODS: We performed an analysis of all patients with ischemic stroke treated with the Merci Clot Retrieval Device at a single academic center outside of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trials. RESULTS: Twenty-four patients were treated with the device. Nine were MERCI trial ineligible: 4 received intravenous (IV) tissue plasminogen activator (tPA), 1 received IV tPA and was younger than 18 years of age, and 4 had time-to-treatment of longer than 8 hours. Mean age was 64 years (range, 14-89 years; 42% women). Median National Institutes of Health Stroke Scale (NIHSS) score was 21 (range, 11-30). Median symptoms-to-procedure-start time was 303 minutes (range, 85-2385 minutes). Recanalization (Thrombolysis in Myocardial Infarction, 2-3) was achieved in 15/24 (63%). In device-only patients, recanalization occurred in 10/16. In patients who failed IV tPA undergoing rescue embolectomy, recanalization was ach eved in 4/5. Three patients unresponsive to device therapy received rescue intra-arterial tPA/abciximab; recanalization was achieved in 2/3. Recanalization was achieved in 3/4 patients in whom treatment was started longer than 8 hours after symptom onset. Asymptomatic hemorrhage occurred in 38%; symptomatic hemorrhage, in 8%. Three device fractures occurred; none worsened clinical outcome. In-hospital mortality was 17%; 90-day mortality, 29%. Good 90-day functional outcome (modified Rankin Scale, ≤2) was achieved by 25% (6/24). CONCLUSIONS: Endovascular mechanical embolectomy is an effective means of achieving revascularization in patients with acute ischemic stroke, including patients with late treatment start and intravenous tPA failure. Device-based therapy achieved recanalization in nearly two thirds of patients and good clinical outcomes in one fourth, with symptomatic hemorrhage in less than one tenth.

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