Manual Clot Retrieval

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Due to the well-documented risks of thrombolytic therapy in stroke patients who present outside of the 3-hr time window, or other exclusions from standard therapy, manual thrombolectomy devices are being tested. One of the more promising of these is the concentric clot retriever device. Data was published in December 2004 from a Phase 1 trial that used this device specifically designed for intracranial embolectomy (39). Twenty-eight patients who presented within 8 hr, with a median NIHSS of 22, were treated. Successful recanalization with mechanical embolec-tomy was achieved in 12 (43%) patients. With the addition of IA rtPA, a total of 18 (64%) patients were recanalized. No symptomatic ICH occurred. At 1 month, 9 of 18 revascularized patients and none of the nonrevascularized patients had achieved significant recovery. However, a 7% complication rate, caused from either the device or the procedure, was reported. The mortality rate at 90 days was 39%.

At present, there is presently lack of clinical experience with the use of manual clot retriever devices for treatment of acute stroke. To further determine if this device should be added to the armamentarium of acute stroke treatment, the NINDS-funded MR and recana-lization of stroke clots using embolectomy (MR-RESCUE) trial is currently enrolling stroke patients, randomizing (with the assistance of MRI perfusion and diffusion studies) those who present within 8 hr to either thrombectomy (with a modified Merci Retriever system) or medical management. The primary outcome will be functional outcome at 3 months.

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