Introduction: Over the past decade, mechanical thrombectomy has become popular for the treatment of acute ischemic stroke. However, limited data is available assessing outcomes of the four FDA-approved devices. This study aims to compare clinical outcomes, efficacy, and safety of first and second generation thrombectomy devices.
Methods: A single-center review was conducted on patients with identifiable arterial thrombi and no pre-intervention arterial dissections treated for acute ischemic stroke with thrombectomy using Merci, Penumbra, Solitaire, or Trevo from January 2008 to June 2014. Primary outcomes included modified Rankin Scale (mRS) at 90 days, recanalization rate (TICI), and incidence of symptomatic hemorrhages. Secondary outcomes included radiographic analysis of percentage area salvaged, discharge location, and 90-day mortality. Univariate analysis using unpaired t-test, Chi-square, and Fisher’s exact tests was performed.
Results: Our first generation (FG) cohort included 99 patients (30 Merci, 69 Penumbra), while the second generation (SG) cohort had 67 (62 Solitaire, 5 Trevo). Compared to FG devices, SG devices yielded higher rates of 90-day mRS = 2 (61.67% SG vs. 22.54% FG, p = 0.000), lower 90-day NIHSS (2.49 vs. 4.71, p = 0.008), higher TICI 2-3 recanalization rates (97.01% vs. 79.80%, p = 0.002), and greater percentage of parenchyma salvaged (62.3% vs. 28.23%, p = 0.002). The SG cohort had greater discharge rates to home or rehabilitation (80.60% vs. 61.62%; p = 0.009). There was no significant difference in the incidence of symptomatic hemorrhages (1.49% SG vs. 7.07% FG, p = 0.145), but there were significantly fewer asymptomatic hemorrhages in the SG group (11.94% vs. 33.33%, p = 0.002) and a trend toward lower 90-day mortality (20.90% vs. 34.34%, p = 0.067).
Conclusions: Our study suggests that second generation devices offer more effective thrombectomy with comparable safety and better clinical and radiographic outcomes than first generation devices in the treatment of acute ischemic stroke.
Patient Care: Clinicians will understand the differences in clinical and radiographic outcomes as determined by the use of first or second generation devices in maximizing recanalization and parenchymal reperfusion after acute ischemic strokes.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) List two goals of acute ischemic stroke intervention, 2) Identify four FDA-approved first and second generation mechanical thrombectomy devices, 3) Compare, in small groups, several effects on clinical outcome (mRS, NIHSS, discharge disposition, 90 day mortality) of first and second generation devices in the endovascular treatment of acute ischemic stroke, 4) Discuss, in small groups, the efficacy (recanalization, percentage of brain salvaged) of both generations, and 5) Evaluate the safety, in terms of incidence of post-intervention hemorrhages, of the mechanical thrombectomy devices.