Multi-MERCI trials

The Multi-MERCI trial was an international multicenter single-arm trial with the main objective of exploring the safety and efficacy of thrombectomy in patients who fail IV rt-PA. In addition, safety and technical efficacy data for a second-generation retriever were collected [24, 27]. The inclusion/exclusion criteria, techniques, and measures of outcome were otherwise similar to the ones used in the MERCI trial. A total of 177 patients were enrolled in the study. The device was deployed in 164 patients who served as the... 

The Pennmbra Stroke Trial was a prospective, single-arm, mnlticenter trial conducted at 24 international centers in the U.S. and Enrope [87]. Inclusion/excln-sion criteria were roughly similar to the ones nsed in the MERCI and Multi-MERCI trials including stroke signs/symptoms with baseline NIHSS >8, symptom dnration between 0 and 8 h, and occlnsion of a treatable vessel on angiography. A total of 125 patients were emolled (mean age, 63.5 13.5 years mean baseline NIHSS, 17.3 5.2 49% female median time from stroke onset to procedure, 4.1 h). The occlusion sites were the ICA (18%), Ml or M2 MCA branches (70%), vertebro-basilar arteries (9%), and other (3%). 

Complete or partial revascnlarization (TIMI 2-3) occurred in 81.6% of the occluded vessels. sICH occurred in 14 of 125 patients (11.2%) and asymptomatic ICH in 21 of 125 patients (16.8%). Good outcomes (mRS <2) at 90 days were achieved by 25% of patients. The 90-day mortality rate was 32.8%. As in the MERCI and Multi-MERCI trials, good neurological outcomes at 90 days were more frequent (29% vs. 9%, p=0.0596), and mortality was less (29% vs. 48%, p=0.1384) with successful compared with unsuccessful recanalization. 

Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. Am J Neuroradiol 2006 27 1177-1182. 

The data for the use of GP Ilb/IIIa inhibitors in conjunction with lAT are even more scant and are limited to case reports [18-23]. Deshmukh et al reported on 21 patients with large vessel occlusion refractory to lAT with rt-PA who were treated with IV and/or lA abcix-imab, eptifibatide, or tirofiban [20]. Twelve patients received IV rt-PA and 18 underwent balloon angioplasty. Complete or partial recanalization was achieved in 17/21 patients. Three patients (14%) had asymptomatic ICH, but there were no cases of sICH. Mangiafico et al described 21 stroke patients treated with IV tirofiban and heparin followed by lA urokinase. Nineteen of these patients also underwent balloon angioplasty. TIMI 2-3 flow was achieved in 17/21 patients. ICH occurred in 5/21 patients (3 sICH and 2 SAH) and was fatal in three patients [23]. Qureshi et al described the use of IA reteplase and intravenous abciximab on 20 stroke patients [22]. There was one sICH. Partial or complete recanalization occurred in 13/20 patients. Conversely, the use of abciximab was predictive of asymptomatic SAH (OR 19.2) in nine patients who received this drug as a study protocol violation in the Multi-MERCI Part 1 trial [24]. 

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