Initial experience with the Penumbra Stroke System for recanalization of large vessel occlusions in acute ischemic stroke.
BACKGROUND
The Penumbra system is a newly approved mechanical device for the treatment of acute stroke designed for better and faster recanalization. We describe our initial experience with the use of this device.


METHODS
We studied 27 consecutive patients with acute ischemic strokes due to arterial occlusions presenting at our center from January to October 2009. The primary outcome was the degree of recanalization measured by thrombolysis in myocardial infarction (TIMI grade 2/3) at the end of the procedure. Secondary end points were the proportion of patients who achieved a modified Rankin scale (mRS) ≤2 at 3 months, all-cause mortality and intracerebral hemorrhage (ICH) on non contrast computed tomography at 24 h. Procedural complications were also recorded.


RESULTS
Of 27 patients (13 male, mean age 61 years) in the study, 22 (81%) patients had anterior circulation strokes and five (18%) had posterior circulation strokes. Twenty-three (85%) patients achieved TIMI grade 2/3 recanalization at completion of the procedure. Excluding five patients who needed use of a second device, the Penumbra system achieved TIMI grade 2/3 recanalization in 67% of patients. Thirteen (48%) patients had mRS ≤2 at 3-month follow-up. Procedural and post-procedural complications included vasospasm (3.7%), distal emboli (48.1%), and ICH (33.3%). The distribution of ICH is as follows: hemorrhagic infarct type 1 (25.9%), parenchymal hemorrhage type 1 (3.7%), and parenchymal hemorrhage type 2 (3.7%). All-cause mortality was 19%.


CONCLUSIONS
High recanalization rates and good clinical outcomes are achievable with the Penumbra system. Complication rates are comparable to a previously published literature.
Menon
Bijoy K
BK
Calgary Stroke Program, University of Calgary, Calgary, AB, Canada. bkmmenon@ucalgary.ca
Hill
Michael D
MD
Eesa
Muneer
M
Modi
Jayesh
J
Bhatia
Rohit
R
Wong
John
J
Hudon
Mark E
ME
Morrish
Will
W
Demchuk
Andrew M
AM
Goyal
Mayank
M
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology; D020767:Intracranial Thrombosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000295:instrumentation*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology