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Stenting in acute stroke: counterpoint
  1. Satoshi Tateshima
  1. Correspondence to Dr Satoshi Tateshima, Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2129A, Los Angeles, CA 90095-7437, USA; stateshima{at}

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The Merci era to Solitaire

The act of intracranial stent placement in acute stroke patients with thromboembolic occlusions was justified based on the premise that the FDA-approved devices did not provide an adequately high recanalization rate and/or a good clinical outcome.1–4 The patients were put on a dual antiplatelet regime after stent placement despite the potential risk of worsening in the intracranial hemorrhage. Past retrospective clinical series on intracranial stent placement in patients with acute stroke demonstrated higher recanalization rates than the Merci (Stryker / Concentric Medical, Mountain View, CA, USA) and Multi-Merci trials with the use of older generation Merci retrievers, hence the benefits might outweigh the potential risk of hemorrhage for a certain subpopulation of acute stroke patients.1–6 The reported recanalization rates and clinical outcomes from medical centers in the USA have not been substantially different among the FDA-approved mechanical thrombectomy or aspiration devices until recently.6 ,7 In 2012, however, primary data from the Solitaire (Covidien/ev3 Neurovascular, Irvine, CA, USA) With the Intention For Thrombectomy (SWIFT) randomized clinical have become available.8 The Solitaire stent retriever arm achieved an end-of-procedure successful recanalization rate (Thrombosis in Cerebral Infarction (TICI) 2A or greater) of 88.9% with 58.2% good mental/motor functioning (modified Rankin Scale (mRS) score 0–2 or improvement in NIH Stroke Scale (NIHSS) score of ≥10).8 This game-changing new generation device is now approved in the USA and the device has been performing as well as that published in the …

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  • Competing interests ST is an employee of University of California, which holds patents on clot retrievers for acute stroke including Merci Retrieval System; a scientific advisory board member of Reverse Medical Corporation that makes a clot retriever for acute stroke; and a consultant of Century Medical Inc., the distributor of Merci Clot Retrieval System in Japan.

  • Provenance and peer review Commissioned; internally peer reviewed.