title: Incidence and outcome of procedural distal emboli using the Penumbra thrombectomy for acute stroke.
abstract: BACKGROUND
  The Penumbra system is effective for recanalization of the primary arterial occlusion (PAO) in acute stroke. However, clinical outcomes are not as promising. The authors hypothesized that the formation of procedural distal emboli (PDE) during mechanical thrombectomy may lead to poorer patient outcomes.
  
  
  METHODS
  A retrospective review of patients with acute ischemic stroke treated with the Penumbra system was undertaken. Patients' outcome was evaluated by comparing discharge National Institute of Health stroke scale and modified Rankin score (mRS) of patients with and without PDE.
  
  
  RESULTS
  Out of 20 patients reviewed, recanalization of PAO was 100%. Six patients (30%) were confirmed to have PDE, of which two died (33.3%) and one (16.7%) had mRS of 2 or less. Of the 14 patients without PDE, three died (21.4%) and six (42.9%) had mRS of 2 or less. In the patient group who survived, mean National Institute of Health stroke scale decrease was only 2.3 in patients with PDE versus a decrease of 10.6 in patients without PDE.
  
  
  CONCLUSIONS
  In spite of PAO recanalization, distal emboli formed subsequent to Penumbra thrombectomy may contribute to poorer clinical outcome in acute stroke patients.
authors.affiliation: Department of Neurology, New York Medical College, Valhalla, New York, USA.
authors.forename: Akira
authors.initials: A
authors.lastname: Todo
authors.forename: Artin
authors.initials: A
authors.lastname: Minaeian
authors.forename: Ramandeep
authors.initials: R
authors.lastname: Sahni
authors.forename: Kuo H
authors.initials: KH
authors.lastname: Chao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome