Monday, March 12, 2012

Mechanical Thrombectomy - Promising, But Still Unsafe

This article is just a retrospective, consecutive case series from Spain reporting outcomes and adverse events from mechanical thrombectomy in acute stroke.  Most of their patients are significantly disabled from their strokes, with NIHSS ranging from 12 to 20 - unlikely to have great outcomes - but 14% developed intraparenchymal hemorrhage and 25% were deceased at 90 days.  Six patients had vessel wall perforation from the thrombectomy device.

The key sentence is the last sentence:
"Clinical efficacy of this approach compared with standard medical therapy remains to be demonstrated in prospective, randomized controlled trials."

When mortality is 25% here, and 33% at 90 days in MERCI, multi-MERCI, and Penumbra trials, I'm still not sure this strategy is quite ready for prime time.  They do report that 54% had a "good outcome", but it's interesting to see that "good outcome" in stroke trials has progressed from Rankin Scores of 0 or 1 in NINDS etc. to ≤2 in these new trials.  They  also don't offer a lot of granularity in their outcomes data.

But, as usual, as long as there are authors out there who "receive consulting and speaker fees from Co-Axia, ev3, Concentric Medical, and Micrus," we'll keep seeing reports like this.

"Manual Aspiration Thrombectomy : Adjunctive Endovascular Recanalization Technique in Acute Stroke Interventions"
http://www.ncbi.nlm.nih.gov/pubmed/22382156

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