American Journal of Neuroradiology 27:2048-2052, November-December 2006
© 2006 American Society of Neuroradiology
INTERVENTIONAL
Endovascular Mechanical Clot Retrieval in a Broad Ischemic Stroke Cohort
a University of California at Los Angeles (UCLA) Stroke Center, Los Angeles, CA
b Department of Neurology, UCLA Medical Center, Los Angeles, CA
c Department of Neurosurgery, UCLA Medical Center, Los Angeles, CA
d Department of Radiological Sciences, UCLA Medical Center, Los Angeles, CA
e Department of Emergency Medicine, UCLA Medical Center, Los Angeles, CA
Address correspondence to Doojin Kim, MD, Department of Neurology, 1245 16th St, Santa Monica, CA 90404; e-mail: dkim{at}mednet.ucla.edu
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 achieved 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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