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Percutaneous mechanical clot removal feasible in acute ischemic stroke
19 August 2008
MedWire News: Percutaneous mechanical clot removal is feasible to treat ischemic stroke, according to a meta-analysis and systematic review of published literature.
"The results of this study are to be interpreted with caution," Latha Stead (Mayo Clinic College of Medicine, Rochester, Minnesota, USA) and colleagues write in the Archives of Neurology. A meta-analysis is not a substitute for randomized, controlled trails that compare devices but can be useful to guide the direction of future research, they add.
Tissue plasminogen activator (tPA), the only drug approved by the US Food and Drug Administration (FDA) for treatment of acute stroke, must be initiated within 180 minutes of stroke onset and many patients have contraindications. The drug is therefore applicable to less than 5% of all stroke patients. Several devices have been developed over the past 12 years since the approval of tPA, of which the MERCI retriever device is now FDA-approved for ischemic stroke patients who are either ineligible for, or fail, intravenous tPA therapy.
The authors identified 114 publications from a search of literature databases encompassing articles published from January 2000 through March 2006. None of these were randomized controlled trials. The meta-analysis included 22 of these articles comprising 147 patients.
The patients were a mean age of 62.6 years and 61.3% were men. The middle cerebral artery (36%) and the posterior circulation (38%) were the most frequently occluded areas. The clot was accessible in 126 patients (86%). Twenty-two per cent of patients had hemorrhage - 18.5% in 81 patients who underwent concurrent thrombolysis, compared with 27.3% of 66 patients without thrombolysis.
In patients with accessible clots, 36% had a good modified Rankin Scale (mRS) score, of 0-2, and 38% died; in those with inaccessible clots, 24% achieved mRS 0-2, and 38% died. Younger age and less severe symptoms on the National Institutes of Health Stroke Scale score were significantly associated with clinical success. Compared with a matched historical cohort of untreated stroke patients, those who underwent mechanical intervention were 14.8 times more likely to achieve mRS 0-2.
