Page 50 - Inaugural Lecture Prof Dr Ahmad Sobri Muda

Neurointervention

The landmark trial of intra - arterial intervention for acute ischemic
stroke, MR CLEAN, concluded that intraarterial treatment
administered within 6 hours of stroke onset was effective and
safe in patients with acute ischemic stroke caused by a proximal
cerebral occlusion. The landscape for early treatment of acute stroke
with the goal of rapid revascularization has dramatically shifted.
Neurointerventional techniques are important in achieving rapid
revascularization, particularly in cases of large vessel occlusion.
And more distal occlusions like MeVO (Medium Vessel Occlusion)
and DVO (Distal Vessel Occlusion) are now possible thanks to
advancements in medical devices and catheter technologies.
The MERCI device was among the first clot retrieval devices
on the market. In a prospective, nonrandomized, multicenter trial,
the MERCI trial investigators demonstrated the effectiveness and
safety of Merci Retriever to open occluded intracranial major
arteries within 8 hours of the onset of stroke symptoms in patient’s
ineligible for intravenous tPA (Wade S. Smith et. al. Stroke
2005). The recanalization was significantly higher than expected.
Individuals with successful recanalization had better neurological
outcomes at 3 months than patients who failed recanalization.
Merci device first deployed locally in a 71-year-old lady
who suffered from acute stroke with LVO of the right MCA. She
presented with left sided weakness and on arrival had a plain CT
showing an ASPECT score of 9. On CT Angiography, limited CT
perfusion revealed the presence of penumbra at the right MCA
territories associated with left M1 segment occlusion of the right
MCA artery (Figure 16). A cerebral angiography confirmed the LVO
in the right MCA’s M1 segment. Following the LVO, mechanical
thrombectomy performed using MERCI device to revascularizes
the MCA. Mechanical thrombectomy has become the standard
treatment for acute stroke with large and medium artery blockage.

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