Saturday, April 07, 2007
Lack of utility of MERCI device
2007 AAN poster p06.127 p.A286 in neurology supplementBarreto et al. Adjunctive MERCI catheter utilization during intraarterial therapy does not benefit unselected ischemic stroke patients. Compared 22 patients receiving MERCI to 144 who received intraarterial therapy without merci at their center (Houston). Results-- patients receiving merci had higher recanalization but did not achieve better outcome.conclusion-- the results remain suboptimal in unselected patients indicating the need for better patient selection.
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2 comments:
Nothing surprising, nice to see a semi formal acknowledgement of what we knew.
I distinctly remember Dr. Fincham (the stroke specialist in Iowa before his protege Dr. Hal Adams took over) would monitor all angiography requests every AM, before the radiology department got hold of them and nix all the ones for patients with a completed stroke, especially a selective carotid study. In those days it did not matter as we (neurologists and neurosurgeons) did all the studies ourselves, and would be taken to the woodshed if we made that kind of an error.
We need to come up a selection criterion for referral for intraarterial rTPA, which by definition would require a selective carotid or vertebral angiogram for access. We are inconsistent in following the existing guidelines.
Whether clot retrieval (an additional procedure) is accomplished is really up to the judgment of the interventionalist. I believe that most disasters happen with attempts to canalize or remove a hard clot. These usually have been there much longer than the deficit, and the duration of the presentation in many cases is a red herring. In other words I believe we are treating the wrong problem by attempting to dislodge hard clots. Further in long segment stenosis such as in the internal carotid at its origin
or in the skull base, it is the distal end of the stenosis that is the embolic source and very difficult to get to.
There are different experience sets in different locations - some with impressive results. As stated this is a dynamic, evolving treatment regimen
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