Mechanical thrombectomy with the Penumbra recanalization device in acute ischemic stroke

Taschner, Christian; Treier, Markus; Schumacher, Martin; Berlis, Ansgar; Weber, W.; Niesen, Wolf‐Dirk

doi:10.1016/j.neurad.2010.09.001

Cited by 21 publications

(7 citation statements)

References 26 publications

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“…The Penumbra system has been reported to offer higher recanalization rates in a short period of time as compared to the Merci retrieval system. 2 – 5 , 8 – 11) The reperfusion catheter of the Penumbra system is produced in sizes 054, 041, 032, and 026 with a dedicated separator attached to each catheter. In Japan, the reperfusion catheter is available in 054, 041, and 032.…”

Section: Discussionmentioning

confidence: 99%

“…The reperfusion catheter is guided to the exact proximal portion of the thrombus, and the thrombus is aspirated by putting the separator into and out of the reperfusion catheter. 2 , 4 , 5 , 8 , 11) The reperfusion catheter with the largest diameter is Penumbra 054, which is frequently used for the thrombus located in the internal carotid artery to the proximal middle cerebral artery M1, and for the vertebral artery to the basilar artery. 11) We had concerns about guiding the catheter to the M1 segment, but the catheter was flexible and easily passed through the internal carotid artery siphon by using a coaxially mounted Penumbra 032.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Acute Cerebral Artery Occlusion Using the Penumbra System: Our Early Experience

Shindo

Kawanishi

Kawakita

et al. 2014

Neurol. Med. Chir.(Tokyo)

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Intravenous recombinant tissue-type plasminogen activator (rt-PA) therapy is highly recommended to patients who are diagnosed with ischemic stroke within 4.5 hours after the onset while mechanical clot retrieval can be attempted in patients who are not indicated for or cannot effectively receive intravenous rt-PA therapy. In this article, we report early treatment outcomes and discuss the usefulness of mechanical clot retrieval using the Penumbra system (Penumbra Inc., Alameda, California, USA), especially in terms of technical cautions during the procedure and adaptability to elderly and high National Institutes of Health Stroke Scale (NIHSS) patients. We included 7 patients with thromboembolic occlusion. Pretreatment NIHSS score ranged from 11 to 36 (mean: 24.9). All patients achieved good recanalization [thrombolysis in cerebral infarction (TICI) grade 2a or greater] without complications. The NIHSS score at 30 days after the treatment ranged between 0 and 28 (mean: 12.4), and improved more than 10 points in 4 of the 7 patients (57.1%). To obtain good recanalization without complications, selection of suitable reperfusion catheter and careful manipulation of separator prefiguring the occluded distal vessels are essential. The improved NIHSS score at 30 days after the treatment may have led to favorable results, such as an increased participation in available rehabilitation programs and the alleviation of the burden of care. Our findings suggest that the Penumbra system might be effective for treatment in elderly patients or patients with high NIHSS score wherein rt-PA therapy is inadvisable or ineffective in ischemic stroke secondary to large vessel occlusion. Recanalization can improve their quality of life on condition that the procedure is performed successfully without serious complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of Acute Cerebral Artery Occlusion Using the Penumbra System: Our Early Experience

Shindo

Kawanishi

Kawakita

et al. 2014

Neurol. Med. Chir.(Tokyo)

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“…However, tPA treatment is restricted to a narrow window, which limits its clinical application [ 16 , 17 ]. In addition, treatment of stroke with tPA increases the risk of cerebral hemorrhage and induces neuronal excitotoxicity [ 18 ]. Studies in vitro and in vivo have demonstrated that the single-chain form of tPA (sc-tPA) selectively strengthens transduction of the N-methyl-D-aspartate receptor (NMDAR) signal and enhances NMDAR-mediated Ca 2+ influx and neurotoxicity in cultured cortical neurons [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Relevant mediators involved in and therapies targeting the inflammatory response induced by activation of the NLRP3 inflammasome in ischemic stroke

Zhao

et al. 2021

J Neuroinflammation

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The nucleotide-binding oligomerization domain (NOD)-like receptor (NLR) family pyrin domain-containing 3 (NLRP3) inflammasome is a member of the NLR family of inherent immune cell sensors. The NLRP3 inflammasome can detect tissue damage and pathogen invasion through innate immune cell sensor components commonly known as pattern recognition receptors (PRRs). PRRs promote activation of nuclear factor kappa B (NF-κB) pathways and the mitogen-activated protein kinase (MAPK) pathway, thus increasing the transcription of genes encoding proteins related to the NLRP3 inflammasome. The NLRP3 inflammasome is a complex with multiple components, including an NAIP, CIITA, HET-E, and TP1 (NACHT) domain; apoptosis-associated speck-like protein containing a CARD (ASC); and a leucine-rich repeat (LRR) domain. After ischemic stroke, the NLRP3 inflammasome can produce numerous proinflammatory cytokines, mediating nerve cell dysfunction and brain edema and ultimately leading to nerve cell death once activated. Ischemic stroke is a disease with high rates of mortality and disability worldwide and is being observed in increasingly younger populations. To date, there are no clearly effective therapeutic strategies for the clinical treatment of ischemic stroke. Understanding the NLRP3 inflammasome may provide novel ideas and approaches because targeting of upstream and downstream molecules in the NLRP3 pathway shows promise for ischemic stroke therapy. In this manuscript, we summarize the existing evidence regarding the composition and activation of the NLRP3 inflammasome, the molecules involved in inflammatory pathways, and corresponding drugs or molecules that exert effects after cerebral ischemia. This evidence may provide possible targets or new strategies for ischemic stroke therapy.

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“…The current treatment for ischemic stroke is limited to the use of "reperfusion methods", i.e., an intravenous or intra-arterial infusion of a thrombolytic agent such as a recombinant tissue plasminogen activator (rt-PA, alteplase); mechanical removal of the clot by surgical intravascular intervention; or a combination of these methods [2][3][4]. These therapies involve a serious risk of complications, such as hemorrhagic transformation and secondary brain edema, which may further exacerbate a patient's condition or lead to death [5].…”

Section: Introductionmentioning

confidence: 99%

Ligands of the Neuropeptide Y Y2 Receptors as a Potential Multitarget Therapeutic Approach for the Protection of the Neurovascular Unit Against Acute Ischemia/Reperfusion: View from the Perspective of the Laboratory Bench

Przykaza

Koźniewska

2021

Transl. Stroke Res.

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Ischemic stroke is the third leading cause of death and disability worldwide, with no available satisfactory prevention or treatment approach. The current treatment is limited to the use of “reperfusion methods,” i.e., an intravenous or intra-arterial infusion of a fibrinolytic agent, mechanical removal of the clot by thrombectomy, or a combination of both methods. It should be stressed, however, that only approximately 5% of all acute strokes are eligible for fibrinolytic treatment and fewer than 10% for thrombectomy. Despite the tremendous progress in understanding of the pathomechanisms of cerebral ischemia, the promising results of basic research on neuroprotection are not currently transferable to human stroke. A possible explanation for this failure is that experiments on in vivo animal models involve healthy young animals, and the experimental protocols seldom consider the importance of protecting the whole neurovascular unit (NVU), which ensures intracranial homeostasis and is seriously damaged by ischemia/reperfusion. One of the endogenous protective systems activated during ischemia and in neurodegenerative diseases is represented by neuropeptide Y (NPY). It has been demonstrated that activation of NPY Y2 receptors (Y2R) by a specific ligand decreases the volume of the postischemic infarction and improves performance in functional tests of rats with arterial hypertension subjected to middle cerebral artery occlusion/reperfusion. This functional improvement suggests the protection of the NVU. In this review, we focus on NPY and discuss the potential, multidirectional protective effects of Y2R agonists against acute focal ischemia/reperfusion injury, with special reference to the NVU.

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Mechanical thrombectomy with the Penumbra recanalization device in acute ischemic stroke

Cited by 21 publications

References 26 publications

Treatment of Acute Cerebral Artery Occlusion Using the Penumbra System: Our Early Experience

Treatment of Acute Cerebral Artery Occlusion Using the Penumbra System: Our Early Experience

Relevant mediators involved in and therapies targeting the inflammatory response induced by activation of the NLRP3 inflammasome in ischemic stroke

Ligands of the Neuropeptide Y Y2 Receptors as a Potential Multitarget Therapeutic Approach for the Protection of the Neurovascular Unit Against Acute Ischemia/Reperfusion: View from the Perspective of the Laboratory Bench

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