Department of Neuroradiology, National Neuroscience Institute, Singapore.
Ann Acad Med Singap. 2009 Sep;38(9):749-55.
Systemic and local intra-arterial thrombolysis in patients with large vessel ischaemic stroke is hampered by poor re-canalisation rates and risk of haemorrhage. The Merci Retrieval System is an endovascular device for removal of acute intracranial thrombus. We present our initial experience using this device in conjunction with existing thrombolytic therapy already in place in our institute.
Prospective data in all patients presenting with large vessel ischaemic stroke treated using the Merci Retrieval System from July 2007 to March 2009 were analysed. Selection criteria for patients were similar to the multi- Merci trial of 2008. We compared re-canalisation rate, National Institutes of Health Stroke Score (NIHSS) and modified Rankin score (mRS) outcomes to the published trial results.
Seventeen patients were reviewed; none suffered immediate post-procedural complications. Fifteen underwent successful thrombus retrieval but in 2 cases the device failed due to technical considerations. Sites of vascular occlusion included: ICA/ICA-'T' junctions 27%, middle cerebral artery 13% and vertebrobasilar artery 60%. Of the 15 patients treated by MERCI with or without adjuvant thrombolytic therapy, complete re-canalisation was achieved in 60%, partial re-canalisation in 20%, partial re-canalisation with persistent distal vessel occlusion in 6% and failure of re-canalisation in 14%. Asymptomatic haemorrhage occurred in 33% and there was 1 death (6%) from symptomatic haemorrhage. Pre-treatment median NIHSS was 17.88 and 9.5 immediately post-treatment. Median mRS at 30 days was 2.6 for patients who achieved complete re-canalisation and 4.5 in failure or partial re-canalisation with or without persistent distal vessel occlusion.
Re-canalisation rates using the Merci Retrieval System was comparable to the multi-Merci trial. Haemorrhagic complications and safety were also found to be satisfactory. Importantly, treatment success with eventual good clinical outcome hinges strongly on the ability of the device to achieve complete re-canalisation.
全身性和局部动脉内溶栓治疗大血管缺血性脑卒中的再通率低，且存在出血风险。Merci 取栓系统是一种用于清除急性颅内血栓的血管内装置。我们介绍了在我院已有的溶栓治疗基础上联合应用该装置的初步经验。
对 2007 年 7 月至 2009 年 3 月期间使用 Merci 取栓系统治疗的大血管缺血性脑卒中患者的前瞻性数据进行了分析。患者选择标准与 2008 年的多 Merci 试验相似。我们将再通率、国立卫生研究院卒中量表（NIHSS）和改良 Rankin 量表（mRS）评分与已发表的试验结果进行了比较。
共 17 例患者接受了回顾性分析，无患者在术后立即发生并发症。15 例患者成功进行了血栓切除术，但由于技术原因，有 2 例装置失败。血管闭塞部位包括：颈内动脉/颈内动脉“T”型交界处 27%，大脑中动脉 13%，椎基底动脉 60%。在接受 Merci 治疗的 15 例患者中，无论是否联合溶栓治疗，完全再通率为 60%，部分再通率为 20%，部分再通伴远端血管持续闭塞率为 6%，再通失败率为 14%。无症状性出血发生率为 33%，症状性出血导致 1 例死亡（6%）。治疗前 NIHSS 中位数为 17.88，治疗后即刻中位数为 9.5。30 天时完全再通患者的 mRS 中位数为 2.6，失败或部分再通伴或不伴远端血管持续闭塞患者的 mRS 中位数为 4.5。
使用 Merci 取栓系统的再通率与多 Merci 试验相当。出血并发症和安全性也令人满意。重要的是，治疗成功并获得良好的临床结局在很大程度上取决于该装置实现完全再通的能力。
