What is the role of mechanical recanalization in the treatment of stroke?

Updated: Nov 30, 2018
  • Author: Andrew Danziger; Chief Editor: L Gill Naul, MD  more...
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Answer

For the endovascular treatment of acute ischemic stroke, the Concentric Retriever, mainly a grasping device, and the Penumbra device, which uses an aspiration function to remove clot, are available. The Multi Mechanical Embolus Retrieval in Cerebral Ischemia (MERCI) trial used the newer generation Concentric retrieval device (L5). Recanalization was demonstrated in approximately 55% of patients who did not receive tPA and in 68% of those for whom tPA was given in a group of patients with acute ischemic stroke presenting within 8 hours of onset of symptoms. Seventy-three percent of patients who failed IV tPA therapy had recanalization following mechanical embolectomy. [123]  The Penumbra trial demonstrated 82% recanalization in patients when using the aspiration function of the Penumbra device. [124]

Multiple randomized controlled trials have shown that, in patients meeting criteria, endovascular therapy in addition to medical management is superior to medical management alone when endovascular thrombectomy is performed within 6-8 hours of a large vessel occlusion acute ischemic stroke in the anterior circulation. The DAWN and DEFUSE 3 trials recently showed that, in patients meeting selection criteria, endovascular thrombectomy is beneficial in large vessel occlusion strokes in the anterior circulation from 6-16 hours from the last time that patient was known to be asymptomatic and that there may be benefit up to 24 hours. [118, 125, 126, 127]


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