Comparison of stent-retriever devices versus the Merci retriever for endovascular treatment of acute stroke

• Published in: American journal of neuroradiology : AJNR Vol. 34; no. 2; pp. 366 - 372
• Main Authors: Broussalis, E, Trinka, E, Hitzl, W, Wallner, A, Chroust, V, Killer-Oberpfalzer, M
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01-02-2013
• Subjects: Acute Disease; Aged; Brain Ischemia - diagnostic imaging; Brain Ischemia - drug therapy; Brain Ischemia - surgery; Cerebral Angiography; Cerebral Hemorrhage - prevention & control; Cerebral Revascularization - adverse effects; Cerebral Revascularization - instrumentation; Cerebral Revascularization - methods; Device Removal - adverse effects; Device Removal - instrumentation; Device Removal - methods; Female; Follow-Up Studies; Humans; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - drug therapy; Infarction, Middle Cerebral Artery - surgery; Interventional; Male; Postoperative Complications - prevention & control; Prospective Studies; Stents; Thrombectomy - adverse effects; Thrombectomy - instrumentation; Thrombectomy - methods; Thrombolytic Therapy; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a3195

Revascularization of large cerebral artery occlusion is the therapeutic goal in stroke therapy. Currently, many recanalization devices are in clinical use. This study compares the outcome parameters, efficacy, and safety of the new generation of stent-retriever devices with the well-established Merci retriever.
All patients who received endovascular mechanical recanalization therapy were prospectively registered. One hundred twenty-two patients were treated with either new stent retrievers, including the Trevo and Solitaire devices, or the Merci retriever system. Recanalization of the occluded vessel was assessed in accordance with the modified TICI score, and outcome parameters, including the NIHSS and mRS scores, were documented. Clinical status was recorded after neurointervention, at time of discharge, and after 90 days.
The mean age of all patients was 68 years; 54% were male, with no statistical differences in demographics between both groups. Successful recanalization (TICI 3 and TICI 2b) was achieved in 82% of patients treated with stent retrievers compared with 62% of patients treated with Merci retrievers (P = .016). In the 90-day follow-up, 65% of patients treated with stent retrievers and 35% of those treated with the Merci had achieved a good (mRS = 0-2) clinical outcome (P = .002). Patients treated with stent retrievers had a significantly shorter treatment time (72 versus 122 minutes, P < .01) and less severe intracerebral hemorrhages (10% versus 28%, P < .01).
Patients treated with Trevo and Solitaire stents had a better revascularization rate, better clinical outcome, and lower complication rate than patients treated with the Merci retriever.