Key Points:
- Preliminary study examines outcomes of mechanical thrombectomy for acute ischemic stroke using novel device
- Rates of recanalization, complications consistent with other stent retrievers
A small study supports the safety and efficacy of a new stent retriever known as the Embolus Retriever with Interlinked Cage (ERIC) for use in patients with acute ischemic stroke. An expert says ERIC offers incremental benefits over other available mechanical endovascular thrombectomy devices.
ERIC is comprised of “several interlinked cage-like spheres (3-5 depending on the model size) fixed on a pusher wire,” write Hélène Raoult, MD, of the University Hospital of Rennes (Rennes, France), and colleagues. “On a cross-sectional view, these nitinol spheres look like a flower with five petals. They are designed for fast clot integration and to prevent distal emboli migration during device retrieval. The design of the device results in limited contact points with the vessel wall, which can potentially reduce vascular trauma. Tantalum radiopaque markers ensure visualization under fluoroscopy.”
In the study—published online May 17, 2016, ahead of print in the Journal of NeuroInterventional Surgery—the investigators looked at data on 34 consecutive patients with acute ischemic stroke treated with ERIC at three centers. The patients (62% men; median age 66 years) were prospectively followed for 6 months. Occlusions were found in the middle cerebral artery in 13 patients, in the terminal carotid artery in 11, and in the basilar artery in 1. Nine patients had tandem occlusions.
Overall, 58.8% of patients received IV thrombolysis. The median time from symptom onset to recanalization was 325.5 min and from puncture to recanalization was 78.5 min.
When ERIC was used as a first-line device, successful recanalization, defined as TICI 2b-3, was achieved in 83.3% of patients. As a second-line device following failure of a previous device, recanalization was successful in 70.0%. The overall recanalization rate was 94.1%.
Successful recanalization was associated with a lower NIH Stroke Scale (NIHSS) score at 24 hours (8 vs 21.5; P = .008) and a lower modified Rankin Scale (mRS) score at 3 months (2.7 vs 5.3; P = .04). A good clinical outcome, defined as an mRS score of 0 to 2, at 3 months was seen in 48.4% patients.
There were 3 procedural complications and 4 asymptomatic hemorrhages.
Incremental Improvement
“The ERIC is an effective and safe device for [mechanical thrombectomy],” write the authors. “Its innovative shape seems particularly interesting for terminal [internal carotid artery] occlusions and as a second-line rescue device.”
To Neurovascular Exchange, Mark J. Alberts, MD, of the University of Texas Southwestern Medical Center (Dallas, TX), described ERIC as an incremental improvement among stent retrievers.
“Stent retrievers have really revolutionized the endovascular treatment of patients with large-artery acute ischemic strokes because it’s been shown that these new devices are safe and effective, the patients benefit, and interventionalists all say they are relatively easy to use,” he said. “Stent retrievers are undergoing continual evolution and testing. . . . [ERIC] is a nice development but not a breakthrough. . . . It’s another tool in our toolbox.”
Source:
- Raoult H, Redjem H, Bourcier R, et al. Mechanical thrombectomy with the ERIC retrieval device: initial experience. J NeuroIntervent Surg. 2016;Epub ahead of print.
Disclosures:
- Drs. Raoult and Alberts report no relevant conflicts of interest.
