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Research ArticleNeurointervention

Higher Degrees of Recanalization after Mechanical Thrombectomy for Acute Stroke Are Associated with Improved Outcome and Decreased Mortality: Pooled Analysis of the MERCI and Multi MERCI Trials

J.D. Fields, H.L. Lutsep and W.S. Smith for the MERCI Multi MERCI Investigators
American Journal of Neuroradiology December 2011, 32 (11) 2170-2174; DOI: https://doi.org/10.3174/ajnr.A2709
J.D. Fields
aFrom the Department of Interventional Neuroradiology (J.D.F.), Dotter Interventional Institute; Department of Neurology (J.D.F.), Neurosciences Critical Care
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H.L. Lutsep
bDepartment of Neurology (H.L.L.), Oregon Stroke Center, Oregon Health and Science University, Portland, Oregon
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W.S. Smith
cDepartment of Neurology (W.S.S.), University of California, San Francisco, San Francisco, California.
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    Fig 1.

    Procedural duration and number of passes stratified by the final TIMI score. A, Mean procedural duration (hours) stratified by final TIMI score. B, Percentage of cases in which ≥4 passes with the Merci retriever were made, stratified by final TIMI score.

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    Fig 2.

    Distribution of functional outcome stratified by TIMI score.

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    Fig 3.

    Unadjusted absolute likelihood of a favorable functional outcome and mortality as a function of TIMI score.

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    Fig 4.

    The effect of each increase of TIMI score on the odds of favorable functional outcome and survival. A, Unadjusted ORs for favorable functional outcome (mRS score of 0–2) as the TIMI grade increases from 0 to 3. B, Unadjusted ORs for survival to 90 days as TIMI grade increases from 0 to 3.

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    Table 1:

    Presenting features

    TIMI 0TIMI 1TIMI 2TIMI 3TotalP
    No. of patients1102061114305
    Age (yr)
        Mean68.1 ± 1564.5 ± 1670.5 ± 14.966.1 ± 16.767.6 ± 15.8NS
        Median (IQR)73 (59.0–80.0)66 (54.0–77.5)75 (63.0–81.0)70 (55.0–79.0)72 (58.0–80.0)
    Female55.5%55.0%52.5%48.2%52.1%NS
    Vessel involved
        Vertebrobasilar6.4%15.0%6.6%12.3%9.2%NS
        Carotid32.7%30.0%27.9%35.1%32.5%
        MCA (M1/M2)60.9%55.0%65.6%52.6%58.4%
    NIHSS score (median) (IQR)20 (16.0–24.0)19 (14.0–22.5)17 (14.0–23.0)18 (15.0–23.0)19 (15.0–23.0)NS
    Baseline mRS (0 or 1)89.1%75.0%83.6%92.9%88.5%NS
    • Note:—IQR indicates interquartile range; NS, not significant.

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    Table 2:

    Procedural details and complications

    TIMI 0TIMI 1TIMI 2TIMI 3TotalP Value
    No. of patients1102061114305
    Ictus to arterial puncture (hr) (mean)
        Median (IQR)4.5 ± 2.14.5 ± 1.64.3 ± 1.64.2 ± 1.54.4 ± 1.8NS
    4.3 (3.0–5.6)4.1 (3.3–5.4)4.4 (3.2–5.7)4.2 (3.1–5.2)4.3 (3.1–5.5)
    Ictus to procedure end (hr) (mean)
        Median (IQR)6.6 ± 2.16.93 ± 2.06.3 ± 1.95.8 ± 1.66.3 ± 1.9.004
    6.5 (5.5–7.8)7.1 (5.7–8.2)6.0 (5.0–7.7)5.8 (4.7–6.9)6.1 (5.0–7.5)
    No. of passes
        19.1%25.0%31.1%34.2%23.9%<.001
        218.2%15.0%16.4%23.7%19.7%
        330.0%15.0%21.3%22.8%24.6%
        413.6%5.0%19.7%11.4%13.4%
        >429.1%40%11.5%7.9%18.4%
    Use of adjuvant40.9%45.0%32.8%36.0%37.7%NS
    Procedure-related clinically significant AE10.0%0.0%6.6%3.5%6.2%.09
    Symptomatic bleeding events12.7%10.0%8.2%5.3%8.9%NS
    PH-2 events9.1%0.0%3.2%3.7%4.9%NS
    • Note:—IQR indicates interquartile range; NS, not significant; AE, adverse events.

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    Table 3:

    Final multivariate model

    OR (95% CI)P Value
    Final TIMI flow (0, 1, 2, 3)2.6 (1.9–3.4)<.0001
    NIHSS score0.89 (0.84–0.94)<.0001
    Age (yr)0.97 (0.95–0.98).0003
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American Journal of Neuroradiology: 32 (11)
American Journal of Neuroradiology
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J.D. Fields, H.L. Lutsep, W.S. Smith
Higher Degrees of Recanalization after Mechanical Thrombectomy for Acute Stroke Are Associated with Improved Outcome and Decreased Mortality: Pooled Analysis of the MERCI and Multi MERCI Trials
American Journal of Neuroradiology Dec 2011, 32 (11) 2170-2174; DOI: 10.3174/ajnr.A2709

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Higher Degrees of Recanalization after Mechanical Thrombectomy for Acute Stroke Are Associated with Improved Outcome and Decreased Mortality: Pooled Analysis of the MERCI and Multi MERCI Trials
J.D. Fields, H.L. Lutsep, W.S. Smith
American Journal of Neuroradiology Dec 2011, 32 (11) 2170-2174; DOI: 10.3174/ajnr.A2709
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