Abstract
The Penumbra Stroke System (PSS) was cleared for use in patients with ischemic stroke by the FDA in January 2008. We describe our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion presented with coma. Median symptom to procedure start time was 151 min. In the anterior circulation, 9 of the 12 target vessels were recanalised successfully (TIMI 2 and 3). The rate of patients with independent clinical outcome (mRS ≤ 2) was 42%. One patient died 5 days after unsuccessful treatment, one after 28 days and one after 85 days owing to heart attack. Basilar artery occlusions could be recanalised in all cases to TIMI 3. The clinical result after 90 days was mRS 4 in two cases and mRS 5 in one case. Symptomatic haemorrhage did not occur. The PSS can safely be used for recanalisation in patients with acute ischemic stroke due to large vessel occlusion, who have already received thrombolysis treatment. The recanalisation rate was 80%. Symptomatic haemorrhage did not occur. Randomized trials may demonstrate that endovascular mechanical thrombectomy improves patient outcome.
Similar content being viewed by others
References
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333(24):1581–1587
Jansen O, Schellinger P, Fiebach J, Hacke W, Sartor K (1999) Early revascularization in acute ischemic stroke saves tissue at risk defined by MRI. Lancet 353:2036–2037
Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J et al (2004) Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 351:2170–2178
Jansen O, von Kummer R, Forsting M, Hacke W, Sartor K (1995) Thrombolytic therapy in acute occlusion of the intracranial internal carotid artery bifurcation. AJNR 16:1977–1986
Brandt T, von Kummer R, Muller-Kuppers M, Hacke W (1996) Thrombolytic therapy of acute basilar artery occlusion. Stroke 27:875–881
Eckert B, Koch C, Thomalla G, Kucinski T, Grzyska U, Roether J et al (2005) Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke 36(6):1160–1165
US Food and Drug Administration (2004) FDA Neurological Devices Panel fifteenth meeting. http://www.fda.gov/ohrms/dockets/ac/05/minutes/2004-4083m1_summary%20minutes.doc. Accessed 6 Nov 2006
Bose A, Henkes H, Alfke K, Reith W, Mayer TE, Berlis A et al (2008) The Penumbra System: amechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 29(7):1409–1413
Köhrmann M, Jüttler E, Huttner HB, Schellinger PD (2007) Thrombolysis for ischemic stroke: an update. Nervenarzt 78(4):393–495
Kalender WA, Kyriakou Y (2007) Flat-detector computed tomography (FD-CT). Eur Radiol 17:2767–2779
Kase CS, Furlan AJ, Wechsler LR, Higashida RT, Rowley HA, Hart RG et al (2001) Cerebral haemorrhage after intra-arterial thrombolysis for ischemic stroke: The PROACT II trail. Neurology 57:1603–1610
Thrombolysis in myocardial infarction (TIMI) trial (1985) Phase 1 findings—TIMI study group. N Engl J Med 312:932–9336
Lewandowski C, Frankel M, Tomsick T, Broderick J, Frey J, Clark W et al (1999) Combined intravenous and intra-arterial rTPA versus intra-arterial therapy on acute ischemic stroke—emergency management of stroke (EMS) bridging trial. Stroke 30:2598–2605
Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK (2004) Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke. Stroke 35(4):876–881
Wildenhain SL, Jungreis CA, Barr J, Mathis J, Wechsler L, Horton JA (1994) CT after intracranial intraarterial thrombolysis for acute stroke. AJNR 15:487–492
Kim D, Jahan R, Starkman S, Abolian A, Kidwell CS, Vinuela F et al (2006) Endovascular mechanical clot retrieval in a broad ischemic stroke Cohort. AJNR 27:2048–2052
Develin TG, Baxter BW, Feintuch TA, Desbiens NA (2007) The Merci Retrieval System for acute stroke: the Southeast Regional Stroke Center experience. Neurocrit Care 6(1):11–21
Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. J Am Med Assoc 274:1017–1025
Heran NS, Song JK, Namba K, Smith W, Niimi Y, Berenstein A (2006) The utility of DynaCT in neuroendovascular procedures. Am J Neuroradiol 27:330–332
Doelken M, Struffert T, Richter G, Engelhorn T, Nimsky C, Ganslandt O et al (2008) Flat-panel detector volumetric CT for visualisation of subarachnoid haemorrhage and ventricles: preliminary results compared to conventional CT. Neuroradiology 50(6):517–523
Engelhorn T, Struffert T, Richter G, Doelken M, Ganslandt O, Kalender W et al (2008) Flat panel detector angiographygraphic CT in the management of aneurysmal rupture during coil embolization. AJNR Am J Neuroradiol 29(8):1581–1584
Struffert T, Richter G, Engelhorn T, Doelken M, Goelitz P, Kalender WA et al (2008) Visualisation of intracerebral haemorrhage with flat-detector CT compared to multislice CT: results in 44 cases. Eur Radiol. doi:10.1007/s00330-008-1183-7
Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP et al (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the Merci trial. Stroke 36:1432–1438
Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C et al (1999) Intra-arterial prourokinase for acute ischemic stroke, the PROACT II study: a randomized controlled trial. JAMA 282:2003–2011
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Struffert, T., Köhrmann, M., Engelhorn, T. et al. Penumbra Stroke System as an “add-on” for the treatment of large vessel occlusive disease following thrombolysis: first results. Eur Radiol 19, 2286–2293 (2009). https://doi.org/10.1007/s00330-009-1390-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-009-1390-x