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Future directions in stroke treatment
Published in Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees, Stroke in Practice, 2017
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees
Pharmacological thrombolysis is associated with systemic and intracranial bleeding complications (seeChapter 7), and rates of recanalisation are variable, particularly in the context of large clot-occluding proximal intracranial vessels. Mechanical thromboembolectomy offers a more direct means of disrupting and extracting such clots, with potential for more timely restoration of blood flow. A number of devices have been developed and some have been approved for use in selected patients with stroke; however, none is commonly used in the UK. The MERCI retriever is among the best-known device: this is a percutaneous catheter-mounted snare that allows the clot to be withdrawn into a more proximal catheter and then removed: recanalisation rates of 68% have been reported when this device is used as an adjunct to thrombolytic therapy.14 Other devices currently under evaluation employ micro-catheter manipulations, stenting (with and without adjuvant GPIIb/IIIa inhibitors), and intra-arterial ultrasound.151617
Simulation of stent retriever thrombectomy in acute ischemic stroke by finite element analysis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Ronghui Liu, Chang Jin, Lizhen Wang, Yisong Yang, Yubo Fan, Weidong Wang
High stress in the clot was mainly concentrated on the surface interacting with the stent retriever along the clot length from proximal to distal. This feature allows the full-length of the thrombus to be retrieved. Different types of mechanical thrombectomy devices may have different interaction areas with a clot. For first-generation mechanical thrombectomy devices (Merci retriever, Concentric Medical), the interaction site is primarily focused on the distal end of a clot (Mordasini et al. 2013). However, for the aspiration catheter, the proximal surface of a clot is the main interacting area. The interaction mechanism between a clot and different types of thrombectomy devices needs to be further investigated. Moderate stress may contribute to clot engagement. However, increased stress, especially for the model with a 10 mm clot and 0.3 friction coefficient, may imply a higher risk of clot fragmentation and distal embolization.
Recent advances in devices for mechanical thrombectomy
Published in Expert Review of Medical Devices, 2020
Raphaël Blanc, Simon Escalard, Humain Baharvadhat, Jean Philippe Desilles, William Boisseau, Robert Fahed, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Benjamin Maier, François Delvoye, Solène Hebert, Mikael Mazighi, Michel Piotin
Solitaire FR (Medtronic Neurovascular, Irvine, California, USA) was the first SR cleared and authorized by the Food and Drug Administration based on the SWIFT study in 2012. In this multicenter, randomized trial, Solitaire was compared to the Merci Retriever as the initial device intervention in 113 AIS patients [10] and showed successful recanalization in 60.7% of patients with Solitaire and only 24.1% with the Merci device. Similarly, the rates of good clinical outcomes (mRS 0-2) at 90 days were superior with the Solitaire 58.2% versus 33.6%, with lower mortality rate 17.2% versus 38.2%.
Functional outcomes of patients with stroke treated with thrombectomy by aspiration
Published in Brain Injury, 2021
E. Rubén Pego Pérez, Isaac Fernández, J. Manuel Pumar
In comparison with scientific evidence, we observed that the reperfusion rates reported for new patients with stent retrievers for example the Trevo Pro with outcomes of 86% TICI 2 and 93% TICI 3 and Solitaire 88.8% have improved compared with Merci Retriever (Thrombolysis in myocardial infarction TIMI 2 or 3: MERCI 48.2% and Multi-MERCI 55% and the Penumbra system TIMI 2 or 3: 81.6%). In general, stent retrievers have shown better recanalization rates and clinical outcomes compared to Merci Retriever (16,26,27).