The Penumbra System: A Mechanical Device for the Treatment of Acute Stroke due to Thromboembolism

Bose, Arani; Henkes, Hans; Alfke, K.; Reith, Wolfgang; Mayer, Thomas; Berlis, Ansgar; Branca, V.; Sit, Siu Po

doi:10.3174/ajnr.a1110

Cited by 318 publications

(219 citation statements)

References 13 publications

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“…Mechanical approaches to arterial recanalization using balloons, snares, or the embolectomy devices have been reported with promising results [56][57][58] (Fig. 2).…”

Section: Mechanical Clot Disruption and Extractionmentioning

confidence: 99%

Intra-arterial Therapy for Acute Ischemic Stroke

Aböu-Chebl

2011

Neurotherapeutics

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Intra-arterial therapy (IAT) for acute ischemic stroke refers to endovascular catheter-based approaches to achieve recanalization using mechanical clot disruption, locally injected thrombolytic agents or both. IAT may be used in addition to intravenous tissue plasminogen activator (tPA) or in patients who do not qualify for tPA, usually because they are outside the approved 3-h timeframe window or have contraindications, such as elevated international normalized ratio or partial thromboplastin time. Recanalization rates correlate with clinical improvement, and with the newest catheters it is possible to achieve recanalization in roughly 80% of patients treated. However, while the catheters are approved by the Food and Drug Administration, there are still no randomized trial data demonstrating the role of current IAT therapy vs either tPA or standard management. IAT is reserved for patients with large artery occlusions in the basilar, distal carotid, or proximal middle cerebral arteries. Imaging the penumbra using magnetic resonance imaging or computed tomographic perfusion is currently the most frequently used way to identify patients who might benefit. However, the imaging and clinical criteria for identifying which patients benefit, and perhaps more importantly those who will do poorly despite IAT, remain unclear.

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“…Mechanical approaches to arterial recanalization using balloons, snares, or the embolectomy devices have been reported with promising results [56][57][58] (Fig. 2).…”

Section: Mechanical Clot Disruption and Extractionmentioning

confidence: 99%

Intra-arterial Therapy for Acute Ischemic Stroke

Aböu-Chebl

2011

Neurotherapeutics

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“…Since its initial approval, this device has been redesigned, resulting in improved recanalization rates, especially when used in conjunction with other modalities [14]. The penumbra device (Penumbra, San Leandro, CA) is an FDA-approved thrombectomy catheter, which demonstrated promising results in a recently reported efficacy trial [15]. Yet, despite the potential benefits of CBT for acute ischemic stroke in patients not eligible for intravenous thrombolysis, the limited workforce of interventional neurovascular specialists (385 nationwide) limits access to around-the-clock CBT for stroke patients [16].…”

Section: Introductionmentioning

confidence: 99%

Acute stroke intervention by interventional cardiologists

DeVries

White

Collins

et al. 2009

Cathet Cardio Intervent

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Objectives: To report the technical success and clinical outcomes of catheter-based therapy (CBT) for acute ischemic stroke in patients ineligible for intravenous thrombolysis. Background: Acute ischemic stroke is common but undertreated. CBT for acute ischemic stroke is a therapeutic option in selected patients who are not candidates for intravenous thrombolysis. Methods: Consecutive stroke patients who were ineligible for intravenous thrombolysis and underwent CBT were identified by retrospective chart review. Demographic information, National Institutes of Health Stroke Scale (NIHSS), procedural characteristics, and clinical outcomes during hospitalization and at 90 days follow up were collected. Experienced interventional cardiologists with the consultative support of stroke neurologists were on call for acute strokes. Results: A total of 33 acute ischemic stroke patients underwent emergency cerebral angiography, with 26 patients undergoing CBT. Successful ' 'culprit' ' artery recanalization was achieved in 23 (88%) of the 26 patients. In-hospital adverse events occurred in 4 (15%) patients, with intracerebral hemorrhage (ICH) (12%) representing the most common adverse event. The baseline NIHSS for patients who underwent intervention was 16.5 6 9.9 (median 16) and improved significantly to 9.9 6 8.7 (median 9) (P < 0.001) at hospital discharge. A modified Rankin score of two or less (indicating mild disability) was achieved in half (n 5 13) of the CBT treated patients. All cause mortality at 90 days was 8% (2/26). Conclusions: In selected patients, CBT provided by qualified interventional cardiologists supported by stroke neurologists, offers a safe and effective option for patients with acute stroke who are not eligible for intravenous thrombolysis. '

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“…These high embolism rates could not be confirmed in clinical use. In 2006, Penumbra (USA) presented a completely different approach: Use of an aspiration catheter with a dedicated aspiration pump together with a specially designed wire for fragmentation of the thrombus, called a separator [24]. The function principle was to suction the thrombus from a proximal position out of the vessel while inducing simultaneous fragmentation with the separator.…”

Section: Review 260mentioning

confidence: 99%

Interventional Ischemic Stroke Treatment – A (R)evolution

Friedrich

Gawlitza

Fahnert

et al. 2015

Fortschr Röntgenstr

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In recent years ischemic stroke caused by an intracranial vessel occlusion has become a treatable disease. Over decades intravenous thrombolysis by recombinant tissue plasminogen activator was the only accepted causal treatment of ischemic stroke supported by the results of randomized, controlled trials. However, there has been continuous development of endovascular treatment strategies over recent years. Today there are 5 prospective, randomized multicenter studies showing the highly significant superiority of endovascular, mechanical recanalization over intravenous thrombolysis in cases of acute occlusion of an intracranial vessel of the anterior circulation. In all those studies endovascular treatment resulted in a tremendous increase in functional independence together with a reduction of mortality without a significant increase in complications. This article reviews the developments resulting in the current data and gives an overview of the present studies focusing on endovascular stroke treatment. Key Points: ??In the last 20 years ischemic stroke due to an main stem occlusion has become a potentially treatable disease. ??Several in 2015 published randomized Multicentener trials could prove the superiority of endovascular, mechanical recanalization over i.v. thrombolysis alone. ?? Acute ischemic stroke due to a main stem occlusion should be treated with swift endovascular stent-retriever based recanalization in specialized neurovascular centers. Citation Format: ??Friedrich B, Gawlitza M, Fahnert J et?al. Interventional Ischemic Stroke Treatment ? A (R)evolution. Fortschr R?ntgenstr 2016; 188: 1???9

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The Penumbra System: A Mechanical Device for the Treatment of Acute Stroke due to Thromboembolism

Cited by 318 publications

References 13 publications

Intra-arterial Therapy for Acute Ischemic Stroke

Intra-arterial Therapy for Acute Ischemic Stroke

Acute stroke intervention by interventional cardiologists

Interventional Ischemic Stroke Treatment – A (R)evolution

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