Maryam Soltanolkotabi MD, Presenter: Nothing to Disclose

Ali Habib BS, Abstract Co-Author: Nothing to Disclose

Ali Shaibani MD, Abstract Co-Author: Nothing to Disclose

Michael Charles Hurley MBBCh, Abstract Co-Author: Nothing to Disclose

Bernard Bendok MD, Abstract Co-Author: Nothing to Disclose

Sameer A. Ansari MD, PhD, Abstract Co-Author: Nothing to Disclose

Stroke is the third-leading cause of death in the USA. Both the MERCI & Penumbra thrombectomy devices have demonstrated near equivalence in single arm trials with respect to the NINDS IV tPA trial, with the benefit of an extended time window for intervention. However, these devices have yet to be juxtaposed to address superiority or sequence of device utilization in a critical time period for intervention. We compared the safety & efficacy of the MERCI & Penumbra devices in the management of hyperacute ischemic stroke patients.

We retrospectively reviewed a consecutive series of hyperacute ischemic stroke interventions that underwent mechanical thrombectomy with the MERCI &/or Penumbra devices between January 2008 & March 2011. Patient demographics, technical outcomes, complications, & clinical outcomes were recorded. Recanalization success was defined with respect to TICI scores>=2a. Statistical analysis was performed to study categorical & numerical data using the X2 and one-way ANOVA tests.  

70 endovascular stroke interventions were treated with MERCI(n=27), Penumbra(n=30), or combination of MERCI/Penumbra(n=13) thrombectomy devices. Subgroups matched in terms of age, gender, & baseline NIHSS. All baseline TICI scores were 0/1. Both MERCI & Penumbra devices were not found to be statistically different in terms of successful recanalization, complications, patient outcome, or mortality. We noted a nonstatistical trend toward more successful recanalization rates with the MERCI device. However, the increased utilization of IA tPA with the MERCI device could have contributed to higher recanalization success(p=.04). There were a total of 16(23%) device-related procedural complications. Symptomatic ICH at 24-48 hours postprocedure was noted in 5(7%) patients altogether. The overall mortality rate was 8(11%). Device cross-over was attempted in difficult cases, where one device fails to recanalize the vessel.

We noted no statistical difference in the safety or technical/clinical efficacy of the MERCI or Penumbra systems. Subjective superiority or operator preference may lead to a specific sequence of device utilization, but both devices can be complementary & device crossover may be required to achieve recanalization success in recalcitrant cases.

There is no statistical significance between the MERCI & Penumbra devices in terms of safety or technical/clinical efficacy.

Soltanolkotabi, M, Habib, A, Shaibani, A, Hurley, M, Bendok, B, Ansari, S, Comparison of Mechanical Thrombectomy Devices in Acute Stroke Intervention: MERCI Retriever versus Penumbra Vacuum Aspiration System.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028793.html