Intracerebral artery revascularization has been shown to be one of the main predictors for good outcome after stroke. Although there is still lack of randomized double blind studies showing that intra arterial thrombolysis could add a benefit to intravenous rTPA therapy, lots of devices and IA techniques have demonstrated the utility of local revascularization.In this paper, the authors addressed a dual technique combining a clot retrieval device (Merci) and thrombus aspiration technique. Using a triaxial technique with distal access catheters and the Merci device in 191 patients, the authors achieved a TICI 2a/2b/3 in 91% of patients. Larger catheter allowed better recanalization rates and the parenchimal hemorrhage ratio did not exceeded usual values.

Contributions of this paper with the use of a combination between Merci and aspiration could be summarized in: 1) an aid for clot aspiration with less repeating use of the retrieval device compared with other trials (Merci and MultiMerci trials) and 2) better stability and distal navigation of the aspiration catheters, given by the Merci, allowing a more proximal to target position for suction.