A revolutionary device based on technology invented in the Division of Interventional Neuroradiology at UCLA.

It is a minimally invasive, catheter- based device designed to treat ischemic stroke by mechanical removal of the blood clots.

The Merci Clot Retriever

Making a Dream Come true

The MERCI story started in fall 1995 while I was treating a stroke patient at UCLA. I was scrubbed with one of our fellows, JP Wensel; we had accessed the MCA thrombus easily but then could not reopen the occlusion despite a two-hour infusion of Urokinase. Frustrated, I thought that we should have a device that would just remove the clot, that should be faster and have less risk of hemorrhage than thrombolytics. After the procedure JP and I started drawing all kind of shapes for an embolectomy device, some very bizarre and most of them impractical of course, but our first idea was a nitinol-made helicoidal device very similar to the current MERCI Retriever. We filed an invention report with the UCLA office of technology transfer and licensed the idea to MIS (Micro Interventional System). We decided to first develop the helicoidal shape idea, and started in vitro and then animal studies in 1996. The first devices were crude and could only be advanced in straight anatomy but they did remove clots. In 1999 Concentric Medical was founded with me as Medical Director. It took us two years before starting the clinical safety study in May 2001. The first two patients treated at UCLA with the MERCI retriever were two full TIMI 3 successes, which encouraged us to continue with the helicoidal configuration of the MERCI Retriever.

The First MERCI Case

In that first case, there were equal parts anxiety and excitement. We, together with our team of excellent Stroke and Emergency Neurologists (headed up by Jeff Saver and Sid Starkman), had been doing intraarterial rtPA[6]. for acute stroke in patients, and had extensive experience in the animal lab with the Merci device (the first one, now called X4). But now we were there, really trying for the first time in a patient. Could we get the microcatheter up to the clot? Would the device deploy? Would we get a dissection or perforation? Would the device really ensnare the clot and pull it out? Would the balloon catheter damage the artery, or would it effectively prevent the clot from going distally into the artery? Could we actually pull the clot into the guide? All of these questions and more were running through our heads as we proceeded. Almost never with a first-ever procedure do things go exactly as hoped, but this case did. We extracted the clot and flow was restored. The patient immediately went from hemiplegic to full strength. With our Stroke Neurology Colleagues in the control room anxiously awaiting the results, it became immediately obvious with our uncontrolled shouts of "YES" and "WooHoo". For Pierre, I am sure that it felt like his babies being born to see all of his work and effort result in success. The glow from that first case kept all of us in the Stroke Team fully energized for weeks and months through the occasional failures, complications, and frustrations. The feeling to be on the frontier of a revolutionary breakthrough in the treatment of a devastating and often fatal disease was indescribable. We continued to learn from each case, identifying problems which lead to new ideas and solutions, which the R & D engineers then put into newer products and techniques which have definitely resulted in greater and greater success in recanalization.

Thirteen Years Later...

Thirteen years after Dr. Wensel and Dr. Gobin made the first drawings of their invention, 10,000 patients have been treated with the MERCI retriever. Concentric developed a first of its kind device at a time when no other companies believed in this technology nor in this market. That would not have happened without the support and advice from all the INRs and Stroke Neurologists, first at UCLA then all around the country. The MERCI retriever opened the way for the mechanical endovascular treatment of stroke, as shown by the current sprouting of many competing devices and technologies in the USA and abroad. There is still a long way to go because wide adoption of embolectomy technology is impaired by the absence of prospective controlled trials. These studies are ongoing or are being designed and if they are well done, we think that they will be positive. We have to prove that early embolectomy benefits patients with large intracranial vessel occlusion, which are responsible for most moderate or severe strokes and for whom IV t-PA is marginally effective. A positive trial will require radical changes in the health system to offer endovascular treatment to the majority of stroke patients: stroke centers would be mandated to offer endovascular therapy, or to quickly transfer these patients to a comprehensive stroke center where it is available. And finally, we will see the treatment of stroke moving from the ER to the Interventional lab.

Raymar Aylwynh D. Pirame and Andrew F. Yu BSN 2B