Mechanical Thrombectomy for Acute Ischemic Stroke: Final Results of the Multi MERCI Trial
Wade S. Smith,Gene Sung,Jeffrey L. Saver,Ronald F. Budzik,Gary Duckwiler,David S Liebeskind,Helmi L. Lutsep,Marilyn M. Rymer,Randall T. Higashida,Sidney Starkman,Y. Pierre Gobin +10 more
TLDR
Higher rates of recanalization were associated with a newer generation thrombectomy device compared with first-generation devices, but these differences did not achieve statistical significance.Abstract:
Background and Purpose— Endovascular mechanical thrombectomy may be used during acute ischemic stroke due to large vessel intracranial occlusion. First-generation MERCI devices achieved recanalization rates of 48% and, when coupled with intraarterial thrombolytic drugs, recanalization rates of 60% have been reported. Enhancements in embolectomy device design may improve recanalization rates. Methods— Multi MERCI was an international, multicenter, prospective, single-arm trial of thrombectomy in patients with large vessel stroke treated within 8 hours of symptom onset. Patients with persistent large vessel occlusion after IV tissue plasminogen activator treatment were included. Once the newer generation (L5 Retriever) device became available, investigators were instructed to use the L5 Retriever to open vessels and could subsequently use older generation devices and/or intraarterial tissue plasminogen activator. Primary outcome was recanalization of the target vessel. Results— One hundred sixty-four patien...read more
Citations
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Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines supersede the prior 2007 guidelines and 2009 updates and support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit.
Journal ArticleDOI
A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
Debbie Beumer,Debbie Beumer,Julie Staals,Jeannette Hofmeijer,Jelis Boiten,J. De Vries,Omid S. Eshghi,Koos Keizer,R. van den Berg,A. van der Lugt,Abstr Act +10 more
TL;DR: In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe.
Journal ArticleDOI
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks.
Journal ArticleDOI
Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke
Joseph P. Broderick,Yuko Y. Palesch,Andrew M. Demchuk,Sharon D. Yeatts,Pooja Khatri,Michael D. Hill,Edward C. Jauch,Tudor G Jovin,Bernard Yan,Frank L. Silver,Ruediger von Kummer,Carlos A. Molina,Bart M. Demaerschalk,Ronald F. Budzik,Wayne M. Clark,Osama O. Zaidat,Tim W. Malisch,Mayank Goyal,Wouter J. Schonewille,Mikael Mazighi,Stefan T. Engelter,Craig S. Anderson,Judith Spilker,Janice Carrozzella,Karla J Ryckborst,L. Scott Janis,Renee H Martin,Lydia D. Foster,Thomas A. Tomsick +28 more
TL;DR: The trial showed similar safety outcomes and no significant difference in functional independence with endovascular therapy after intravenous t-PA, as compared with intravenoust-PA alone.
Journal ArticleDOI
A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke
Chelsea S. Kidwell,Reza Jahan,Jeffrey Gornbein,Jeffry R. Alger,Val Nenov,Zahra Ajani,Lei Feng,Brett C. Meyer,Scott E Olson,Scott E Olson,Lee H. Schwamm,Albert J Yoo,Randolph S. Marshall,Philip M. Meyers,Dileep R. Yavagal,Max Wintermark,Judy Guzy,Sidney Starkman,Jeffrey L. Saver +18 more
TL;DR: A favorable penumbral pattern on neuroimaging did not identify patients who would differentially benefit from endovascular therapy for acute ischemic stroke, nor was embolectomy shown to be superior to standard care.
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Intra-arterial Prourokinase for Acute Ischemic Stroke: The PROACT II Study: A Randomized Controlled Trial
Anthony J. Furlan,Randall T. Higashida,Lawrence R. Wechsler,Michael Gent,Howard A. Rowley,Carlos S. Kase,Michael S. Pessin,Arvind Ahuja,Fred Callahan,Wayne M. Clark,Frank L. Silver,Frank Rivera +11 more
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Journal ArticleDOI
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Nils Wahlgren,Niaz Ahmed,Antoni Dávalos,Gary A. Ford,Martin Grond,Werner Hacke,Michael G. Hennerici,Markku Kaste,Sonja Kuelkens,Vincent Larrue,Kennedy R. Lees,Risto O. Roine,Lauri Soinne,Danilo Toni,Geert Vanhooren +14 more
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Journal Article
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