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Intracranial Strokes: Mechanical Thrombectomy Using the Merci and Penumbra Devices

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Endovascular Interventions

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Abstract

The use of catheter-directed, endovascular mechanical thrombolysis has revolutionized the treatment of acute ischemic strokes in the last few years. Acute ischemic stroke remains the third most common cause of death and the first most common cause of permanent adult disability in industrialized nations. Each year, approximately 795,000 people experience a new or recurrent stroke in the USA, with its direct and indirect annual cost estimated as more than $40 billion. The only Food and Drug Administration (FDA)-approved medical therapy for acute ischemic stroke is the intravenous (IV) administration of recombinant tissue-type plasminogen activator (rtPA) within 3 h of symptom onset. The European Cooperative Acute Stroke Study (ECASS) III trial expanded the utilization of IV rtPA up to 4.5 h from symptom onset, albeit with more contraindications. Given this restricted therapeutic window, less than 1 % of acute ischemic stroke patients receive IV rtPA. Moreover, the recanalization rates of IV rtPA for proximal, large vessel occlusions range from only 10 % for internal carotid artery (ICA) occlusions to 30 % for middle cerebral artery (MCA) occlusions.

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Abbreviations

ACT:

Activated coagulation time

AIS:

Acute ischemic stroke

AP:

Anteroposterior

CT:

Computed tomographic

ECASS:

European Cooperative Acute Stroke Study

FDA:

Food and Drug Administration

F:

French

ICA:

Internal carotid artery

IMS:

Interventional Management of Stroke

IV:

Intravenous

MCA:

Middle cerebral artery

MERCI:

Mechanical Embolus Removal in Cerebral Ischemia

mRS:

Modified Rankin Scale

NIHSS:

National Institutes of Health Stroke Scale

POST:

Post-market experience of the Penumbra system trial

PTT:

Partial thromboplastin time

rtPA:

Recombinant tissue-type plasminogen activator

SARIS:

Stent-Assisted Recanalization in acute ischemic Stroke

TIMI:

Thrombolysis in Myocardial Infarction

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    Jorge L. Eller MD

  2. Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA

    Jorge L. Eller MD, L. Nelson Hopkins MD & Elad I. Levy MD

  3. Department of Neurosurgery, Buffalo General Medical Center, Buffalo, NY, USA

    Jorge L. Eller MD

  4. Department of Neurosurgery and Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    L. Nelson Hopkins MD & Elad I. Levy MD

  5. Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    L. Nelson Hopkins MD & Elad I. Levy MD

  6. Jacobs Institute, Buffalo, NY, 14203, USA

    L. Nelson Hopkins MD

Authors
  1. Jorge L. Eller MD
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  2. L. Nelson Hopkins MD
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  3. Elad I. Levy MD
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Editor information

Editors and Affiliations

  1. Edward Hines, Jr. VA Hospital Loyola University Medical Center, Glen Ellyn, Illinois, USA

    Robert S. Dieter

  2. Northern Illinois Surgery Center, Naperville, Illinois, USA

    Raymond A. Dieter, Jr.

  3. University of Tennessee Medical Center, Knoxville, Tennessee, USA

    Raymond A. Dieter, III

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Eller, J.L., Hopkins, L.N., Levy, E.I. (2014). Intracranial Strokes: Mechanical Thrombectomy Using the Merci and Penumbra Devices. In: Dieter, R., Dieter, Jr., R., Dieter, III, R. (eds) Endovascular Interventions. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7312-1_1

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  • DOI: https://doi.org/10.1007/978-1-4614-7312-1_1

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7311-4

  • Online ISBN: 978-1-4614-7312-1

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