title: Acute stroke treatment using the Penumbra endovascular mechanical thrombolysis device: a single-centre experience.
abstract: OBJECTIVE
  Ischaemic stroke due to occlusion of large cerebral vessels has a poor prognosis. The clinical outcome is related to efficacy and timing of recanalisation of the occluded arteries. We report our experience with a thrombus aspiration device (Penumbra), and focus on pre- and postprocedural management.
  
  
  METHODS
  We retrospectively reviewed 18 consecutive patients with acute ischaemic stroke due to the occlusion of large cerebral vessels who were treated with mechanical thrombolysis at our centre between September 2009 and July 2010. Preprocedural symptoms were quantified using the National Institutes of Health Stroke Scale (NIHSS). Mechanical thrombolysis was performed with the Penumbra system. Intravenous thrombolysis was done only if <3 h had elapsed since symptom onset. Associated vessel stenoses were treated with stenting. All patients underwent neurological examination and postprocedural magnetic resonance angiography (MRA) at 3 and 6 months.
  
  
  RESULTS
  Mechanical thrombolysis using the Penumbra system was performed in all cases. A total of 83% of treated vessels had a value of 2/3 according to the Thrombolysis in Cerebral Infarction (TICI) scale. In seven patients (39%) intravenous thrombolysis was unsuccessful, and salvage mechanical thrombolysis followed. Three patients died after the procedure (16.7%). Five patients (27.8%) required a stenting procedure. All patients reported a significant improvement in symptoms (mean baseline NIHSS 19.6±5.6; mean postprocedural NIHSS, 7.8±5.5 p<0.0001)
  
  
  CONCLUSIONS
  Our preliminary experience with the Penumbra mechanical thrombolysis system confirms previously reported results showing the efficacy and safety of the device in treating acute stroke caused by the occlusion of large intracranial vessels.
authors.affiliation: Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Gandini
authors.forename: E
authors.initials: E
authors.lastname: Pampana
authors.forename: C
authors.initials: C
authors.lastname: Del Giudice
authors.forename: F
authors.initials: F
authors.lastname: Massari
authors.forename: S
authors.initials: S
authors.lastname: Spano
authors.forename: E P
authors.initials: EP
authors.lastname: Assako Ondo
authors.forename: E
authors.initials: E
authors.lastname: Salvatori
authors.forename: F
authors.initials: F
authors.lastname: Sallustio
authors.forename: G
authors.initials: G
authors.lastname: Koch
authors.forename: P
authors.initials: P
authors.lastname: Stanzione
authors.forename: G
authors.initials: G
authors.lastname: Simonetti
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000628:therapy*; D016896:Treatment Outcome