Souers Stroke Institute, St. Louis University, St. Louis, MO, USA.
Neurology. 2012 Sep 25;79(13 Suppl 1):S126-34. doi: 10.1212/WNL.0b013e3182697e89.
Mechanical thrombectomy is a promising adjuvant or stand-alone therapy for acute ischemic stroke (AIS) caused by occlusion of a large vessel in patients beyond the systemic thrombolysis therapeutic window. This review focuses on the clinical and angiographic outcomes of mechanical thrombectomy with use of the Merci retriever device.
Available literature published to date on the major trials and observational studies involving the Merci retriever was reviewed. In addition to the review, results from studies involving the Merci retriever were compared to results from Prolyse in Acute Cerebral Thromboembolism II (PROACT II) and the Penumbra device studies. The predictors for favorable outcome following revascularization with the Merci device were reviewed on the basis of published stratified analyses. Favorable clinical outcome was defined in the Merci experience by a modified Rankin Scale (mRS) score of ≤ 2 at 90 days following AIS.
Presented in this review are a total of 1,226 patients treated with the Merci device; 305 patients are from 2 pivotal trials involving the device, and the remaining 921 patients are from observational studies in the Merci registry. The 90-day mRS of ≤ 2 was achieved in 32% of the patient group, with an overall mortality rate of 35.2%. Symptomatic intracerebral hemorrhage was identified in 7.3% of patients treated with Merci retriever, a result comparable to that in the PROACT II and Penumbra thrombectomy trials. Successful recanalization, lower NIH Stroke Scale score, and younger age were identified as the strongest predictors of favorable outcomes.
Mechanical thrombectomy with the Merci retriever device is a safe treatment modality for AIS patients presenting with a large-vessel occlusion within 8 hours of symptom onset. Although the Merci retriever showed a good recanalization rate, there are currently no randomized clinical trials to assess its clinical efficacy in comparison with systemic thrombolysis within a window of 3 to 4.5 hours or with standard of care beyond a 4.5-hour window.
机械血栓切除术是一种有前途的辅助或独立治疗方法，适用于超过全身溶栓治疗时间窗的大血管闭塞引起的急性缺血性脑卒中（AIS）患者。本综述重点介绍使用 Merci 取栓器进行机械血栓切除术的临床和血管造影结果。
对目前已发表的关于 Merci 取栓器的主要试验和观察性研究的文献进行了回顾。除了综述外，还将 Merci 取栓器研究的结果与 PROACT II 和 Penumbra 装置研究的结果进行了比较。根据发表的分层分析，回顾了 Merci 装置血管再通后有利结局的预测因素。Merci 经验中，通过改良 Rankin 量表（mRS）评分，90 天 AIS 后≤2 定义为有利的临床结局。
本综述共纳入 1226 例接受 Merci 装置治疗的患者；305 例患者来自涉及该装置的 2 项关键试验，其余 921 例患者来自 Merci 登记处的观察性研究。该患者组 90 天 mRS≤2 的比例为 32%，总死亡率为 35.2%。接受 Merci 取栓器治疗的患者中，有 7.3%发生症状性颅内出血，与 PROACT II 和 Penumbra 血栓切除术试验结果相当。成功再通、较低的 NIH 卒中量表评分和较年轻的年龄被确定为有利结局的最强预测因素。
对于症状发作 8 小时内出现大血管闭塞的 AIS 患者，使用 Merci 取栓器进行机械血栓切除术是一种安全的治疗方法。尽管 Merci 取栓器显示出良好的再通率，但目前尚无随机临床试验来评估其在 3 至 4.5 小时溶栓治疗窗口内或在 4.5 小时后治疗窗口内与标准治疗相比的临床疗效。
