Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke

作者：Wade S. Smith, Gene Sung, Sidney Starkman, Jeffrey L. Saver, Chelsea S. Kidwell, Y. Pierre Gobin, Helmi L. Lutsep, Gary M. Nesbit, Thomas Grobelny, Marilyn M. Rymer, Isaac E Silverman, Randall T. Higashida, Ronald F. Budzik, Michael P. Marks · 发表于：Stroke · 年份：2005 · DOI：10.1161/01.str.0000171066.25248.1d · 被引用次数：1315 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Venous Thromboembolism Diagnosis and Management

BACKGROUND AND PURPOSE: The only Food and Drug Administration (FDA)-approved treatment for acute ischemic stroke is tissue plasminogen activator (tPA) given intravenously within 3 hours of symptom onset. An alternative strategy for opening intracranial vessels during stroke is mechanical embolectomy, especially for patients ineligible for intravenous tPA. METHODS: We investigated the safety and efficacy of a novel embolectomy device (Merci Retriever) to open occluded intracranial large vessels within 8 hours of the onset of stroke symptoms in a prospective, nonrandomized, multicenter trial. All patients were ineligible for intravenous tPA. Primary outcomes were recanalization and safety, and secondary outcomes were neurological outcome at 90 days in recanalized versus nonrecanalized patients. RESULTS: Recanalization was achieved in 46% (69/151) of patients on intention to treat analysis, and in 48% (68/141) of patients in whom the device was deployed. This rate is significantly higher than that expected using an historical control of 18% (P<0.0001). Clinically significant procedural complications occurred in 10 of 141 (7.1%) patients. Symptomatic intracranial hemorrhages was observed in 11 of 141 (7.8%) patients. Good neurological outcomes (modified Rankin score < or =2) were more frequent at 90 days in patients with successful recanalization compared with patients with unsuccessful recanalization (46% versus 10%; relative risk [RR], 4.4; 95% CI, 2.1 to 9.3; P<0.0001), and mo...