Mechanical embolectomy by means of the Merci retriever in patients with acute occlusion of brain arteries

Česká verzia

Authors: F. Charvát ¹; J. Lacman ¹; J. Mašková ¹; J. Elis ²; V. Beneš ³
Authors place of work: RDG oddělení ÚVN Praha 6 – Střešovice ¹; Neurologické oddělení ÚVN Praha – Střešovice ²; Neurochirurgická klinika, Univerzita Karlova v Praze, 1. lékařská fakulta, IPVZ a ÚVN Praha – Střešovice ³
Published in the journal: Cesk Slov Neurol N 2008; 71/104(1): 69-74
Category: Short Communication

Summary

Objectives:
The authors present their first experience with mechanical embolectomy as a treatment modality for patients with acute cerebral ischemia. Methods: From July to December 2006 mechanical embolectomy was performed in a group of 7 patients (5 men and 2 women) who presented with symptoms of acute brain artery occlusion (NIHSS score 5-25). After a CT scan including CT perfusion, embolectomy by means of the Merci Retriever was urgently performed. The basilar artery was occluded in three patients, M1 in two and M2 in one patient. ICA and parts of the M1 and A1 (T-occlusion) were affected in one patient.

Results:
Successful reperfusion was achieved in six patients (85,8 %) and no serious periprocedural complications were observed during the treatment. Intraarterial administration of alteplase (3 mg) was necessary to dissolve distal emboli in one patient, PTA of the basilar artery due to stenosis was performed in two cases and in one patient stenosis of the internal carotis artery was resolved by stent implantation. The resulting Rankin Score 30 days following treatment was 1 or 2 in 5 cases (71,4 %), 5 in one and one patient died within 30 days after treatment.

Conclusion:
Mechanical embolectomy proved to be a suitable treatment modality for selected patients with acute cerebral ischemia as it is very effectively able to revascularize occluded artery in an eight-hour therapeutic window.

Key words:
stroke, mechanical embolectomy, therapeutic window

Zdroje

1. Krajina A, Krajíčková D, Lojík M, Žižka J, Náhlovský J, Ungermann L. Endovaskulární léčba při ischemických cévních mozkových příhodách. In: Krajina A, Peregrin JH. Intervenční radiologie-miniinvazivní terapie. 1 ed. Hradec Králové: Olga Čermáková 2005: 382-396.

2. Školoudík D, Bar M, Mikulík R, Neumann J, Václavík D, Herzig R et al. Standard pro podání systémové trombolýzy pacientům s akutním mozkovým infarktem. Neurol pro praxi 2006; 1: 53-56.

3. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke. Results of the MERCI Trial. Stroke 2005; 36: 1432-1428.

4. Kalina M. Akutní neurologie. Intenzivní péče v neurologii. Praha: Triton 2000: 172-175.

5. Junghans U, Seitz RJ, Wittsack HJ, Aulich A, Siebler M. Treatment of acute basilar artery thrombosis with a combination of systemic alteplase and tirofiban, a nonpeptide platelet glycoprotein IIb/IIIa inhibitor: Report of four cases. Radiology 2001; 221: 795-801.

6. The TIMI Study Group. Special Report. The thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med 1985; 312: 932-936.

7. Welch K. Excision of occlusive lesions of the middle cerebral artery. J Neurosurgery 1956; 13: 73-80.

8. Meyer FB, Piepgras DG, Sundt TJ, Yanagihara T . Emergency embolectomy for acute occlusion of the middle cerebral artery. J Neurosurgery 1985; 62: 639-647.

9. Fogarty TJ, Cranley JJ, Krause RJ, Strasser ES, Hafner CD. A method for extraction of arterial emboli and trombi. Surg Gynecol Obst 1963; 116: 241.

10. Davie JC, Richardson R. Distal internal carotid thrombo-embolectomy using a Fogarty catheter in total occlusion. J Neurosurgery 1967; 27: 171-177.

11. Konig HJ, Krahling KH, Brandt M. Carotid-cavernous sinus fistula as a complication of embolectomy using a Fogarty catheter. Neurosurg Rev 1981; 4: 191-192.

12. Wikholm G. Mechanical intracranial embolectomy: A report of two cases. Int Neuroradiol 1998; 4: 159-164.

13. Wikholm G. Transarterial embolectomy in acute stroke. Am J Neuro-Radiol 2003; 24: 892-894.

14. Mayer TE, Hamann GF, Brueckmann HJ. Treatment of basilar artery embolism with a mechanical extraction device. Stroke 2002; 33: 2232-2235.

15. Krajina A, Krajíčková D, Špriňar Z, Nikolov DH, Pařízková R, Lojík M et al. Mechanická perkutánní extrakce embolu při akutní cévní mozkové příhodě: kazuistika a přehled literatury. Česk Slov Neurol N 2005; 65/101: 51-57.

16. Beneš V, Zabramski JM, Boston M, Puca A, Spetzler RF. Effect of intraarterial tissue plasminogen activator and urokinase on autologous arterial emboli in the cerebral circulation. Stroke 1990; 21: 1594-1599.

17. Combined intravenous and intra-arterial recanalization for acute ischemic stroke: The interventional management of stroke study. Stroke. 2004; 35: 904–911.

18. Nesbit GM, Luh G, Tien R, Barnwell SL. New and future endovascular treatment strategies for acute ischemic stroke. J Vasc Intervent Radiol 2004; 15: 103-110.

19. Školoudík D, Bar M, Škoda O, Václavík D, Hradílek P, Šimíčková K. Bezpečnost a účinnost trombotripse- akcelerace trombolýzy pomocí ultrazvuku. Česk Slov Neurol N 2004; 67/100: 157-161.

20. Bellon RJ, Putman CM, Budzik RF, Pergolizzi RS, Reinking GF, Norbash AM. Rheolytic thrombectomy of the occluded internal carotid artery in the setting of acute ischemic stroke. Am J Neuroradiol 2001; 22: 526-530.

21. Del Zoppo GJ, Higashida R, Furlan AJ, Pesssin MS, Rowley HA, Gent M. PROACT: a phase II randomised trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke: PROACT Investigators: prolyse in acute cerebral thromboembolism. Stroke 1998; 29: 4-11.

22. Becker KJ, Monsein LH, Ulatowski J, Mirski M, Williams M, Hanley DF. Intraarterial thrombolysis in vertebrobasilar occlusion. Am J Neuroradiol 1996; 17: 255-262.

23. Morgan MK, Grinnell V, Little NS, Day MJ. Successful treatment of an acute stroke thrombosis of an intracranial vertebral artery endarterectomy with urokinase. Neurosurgery 1994; 35: 978-981.

24. Kim D, Jahan R, Starkman S, Abolian A, Kidwell CS, Vinuela F et al. Endovascular mechanical clot retrieval in a broad ischemic stroke cohort. Am J Neuroradiology 2006; 27: 2048-2052.

25. Furlan AJ, Fischer M. Devices, drugs, and the Food and Drug Administration: increasing implications for ischemic stroke. Stroke. 2005; 36(2): 398-399.

26. Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Rotta JC et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 2000; 55: 1649-1655.

27. MR rescue: MR and recanalization of stroke clots using embolectomy. Available from URL: http://clinicaltrials.gov/ct/show/NCT00094588.