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Safety of Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke. Results of the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) Trial, Part I

W.S. Smith for the Multi MERCI Investigators


Figure 1
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  		Fig 1. Illustration of the L5 thrombectomy device removing thrombus. The L5 device is a helix of flexible nitinol wire with an arcade of filaments secured to the loops of the helix. This differs from the X5 and X6 Merci Retrievers by having filaments and no taper to the coils. Within 8 hours of acute ischemic stroke, the balloon guide catheter is placed via femoral artery into the proximal internal carotid or vertebral artery. The blue microcatheter is advanced through the balloon guide catheter and placed through the occlusion using a microguidewire. The guidewire is then exchanged for the Retriever, which is advanced distal to the clot and several loops are deployed (A). The device is further deployed so as to fully ensnare the clot (B). Then, the proximal balloon of the guide is inflated to prevent distal embolization, some torquing maneuvers are applied, and the microcatheter and Retriever are withdrawn together to retrieve the clot (C).


Figure 2
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  		Fig 2. Multi MERCI patient flow and primary outcomes. Recanalization is from device alone; final recanalization is after Retriever and any adjuvant therapy. Patients with symptomatic intracranial hemorrhage (ICH), and procedural complications may overlap.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X