Thrombolytic and newer mechanical device treatment for acute ischemic stroke

Abstract

For 8 years, only intravenous tissue plasminogen activator was approved by the US FDA for acute stroke treatment. The US FDA has now cleared the Merci^® Retriever (Concentric Medical, Inc.), a corkscrew-like device attached to a catheter, for the removal of clots causing ischemic strokes. Since the clearance was based on nonrandomized treatment trials, practitioners must scrutinize available data describing effects of the device on recanalization of the vessel, outcomes and important adverse events, such as symptomatic intracranial hemorrhage. This article reviews the study findings that are likely to contribute to current treatment decisions.

Keywords::

• acute stroke treatment
• device
• intra-arterial
• mechanical thrombolysis
• Merci Retriever
• stroke
• tissue plasminogen activator

Notes

aPTT: Activated partial thromboplastin time; AVM: Arteriovenous malformation; CT: Computed tomography; DBP: Diastolic blood pressure; GI: Gastrointestinal;

GU: Genito-urinary; INR: International normalized ratio; i.v.: Intravenous; NIH: National Institutes of Health; SBP: Systolic blood pressure.

Modified from [23].