Ischemic stroke surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
===Ischemic Stroke== | ===Ischemic Stroke=== | ||
====Mechanical Thrombectomy==== | ====Mechanical Thrombectomy==== | ||
Another intervention for acute ischemic stroke is removal of the offending thrombus directly. This is accomplished by inserting a catheter into the [[femoral artery]], directing it into the [[cerebral circulation]], and deploying a corkscrew-like device to ensnare the clot, which is then withdrawn from the body. In August 2004, based on data from the MERCI (Mechanical Embolus Removal in [[Cerebral ischemia|Cerebral Ischemia]]) Trial, the FDA cleared several of these devices, called the Merci X5 and X6 Retrievers.<ref>{{cite journal |author=Smith WS, Sung G, Starkman S, ''et al'' |title=Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial |journal=Stroke |volume=36 |issue=7 |pages=1432-8 |year=2005 |pmid=15961709 |doi=10.1161/01.STR.0000171066.25248.1d|url=http://stroke.ahajournals.org/cgi/content/full/36/7/1432}}</ref><ref name="FDA2004-MerciRetriever">{{cite web | author=Celia Witten | year=2004 | title=Concentric Merci Retriever product licence |url=http://www.fda.gov/cdrh/pdf3/k033736.pdf | format=PDF | publisher=FDA}}</ref> | Another intervention for acute ischemic stroke is removal of the offending thrombus directly. This is accomplished by inserting a catheter into the [[femoral artery]], directing it into the [[cerebral circulation]], and deploying a corkscrew-like device to ensnare the clot, which is then withdrawn from the body. In August 2004, based on data from the MERCI (Mechanical Embolus Removal in [[Cerebral ischemia|Cerebral Ischemia]]) Trial, the FDA cleared several of these devices, called the Merci X5 and X6 Retrievers.<ref>{{cite journal |author=Smith WS, Sung G, Starkman S, ''et al'' |title=Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial |journal=Stroke |volume=36 |issue=7 |pages=1432-8 |year=2005 |pmid=15961709 |doi=10.1161/01.STR.0000171066.25248.1d|url=http://stroke.ahajournals.org/cgi/content/full/36/7/1432}}</ref><ref name="FDA2004-MerciRetriever">{{cite web | author=Celia Witten | year=2004 | title=Concentric Merci Retriever product licence |url=http://www.fda.gov/cdrh/pdf3/k033736.pdf | format=PDF | publisher=FDA}}</ref> | ||
Revision as of 16:31, 1 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Surgery
Ischemic Stroke
Mechanical Thrombectomy
Another intervention for acute ischemic stroke is removal of the offending thrombus directly. This is accomplished by inserting a catheter into the femoral artery, directing it into the cerebral circulation, and deploying a corkscrew-like device to ensnare the clot, which is then withdrawn from the body. In August 2004, based on data from the MERCI (Mechanical Embolus Removal in Cerebral Ischemia) Trial, the FDA cleared several of these devices, called the Merci X5 and X6 Retrievers.[1][2] The newer generation Merci L5 Retriever was additionally used in the Multi MERCI trial.[3][4] Both the MERCI and Multi MERCI trials required the first pass with the Merci Retriever to be initiated within 8 hours of onset of symptoms.
Hemorrhagic Stroke
Patients with bleeding into (intracerebral hemorrhage) or around the brain (subarachnoid hemorrhage), require neurosurgical evaluation to detect and treat the cause of the bleeding.
References
- ↑ Smith WS, Sung G, Starkman S; et al. (2005). "Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial". Stroke. 36 (7): 1432–8. doi:10.1161/01.STR.0000171066.25248.1d. PMID 15961709.
- ↑ Celia Witten (2004). "Concentric Merci Retriever product licence" (PDF). FDA.
- ↑ Smith WS (2006). "Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I". AJNR Am J Neuroradiol. 27 (6): 1177–82. PMID 16775259.
- ↑ Smith WS, Sung G, Saver J; et al. (2008). "Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial". Stroke. 39 (4): 1205–12. doi:10.1161/STROKEAHA.107.497115. PMID 18309168.