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Acute stroke treatment using the Penumbra endovascular mechanical thrombolysis device: a single-centre experience

Trattamento dell’ictus ischemico acuto mediante trombolisi meccanica endovascolare con dispositivo Penumbra: esperienza di un singolo centro

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
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Abstract

Purpose

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.

Materials and 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.

Riassunto

Obiettivo

L’ictus ischemico dovuto ad occlusione di vasi cerebrali di grosso calibro ha una prognosi infausta. I risultati clinici sono correlati all’efficacia e tempestività della ricanalizzazione dell’arteria occlusa. Riportiamo la nostra esperienza con un dispositivo di trombo aspirazione focalizzando l’attenzione sulla gestione pre- e postprocedurale.

Materiali e metodi

Riportiamo retrospettivamente i risultati di 18 pazienti consecutivi affetti da ictus ischemico acuto dovuto ad occlusione di vasi cerebrali di grosso calibro trattati con trombolisi meccanica nel nostro centro tra settembre 2009 e luglio 2010. I sintomi pre-procedurali sono stati quantificati attraverso la National Institute of Health Stroke Scale (NHISS). La trombolisi meccanica è stata condotta utilizzando il sistema Penumbra. La trombolisi endovenosa è stata effettuata solamente laddove il tempo dall’esordio della sintomatologia fosse inferiore alle 3 ore. Le stenosi dei vasi associate sono state trattate mediante stenting. Tutti i pazienti hanno eseguito un esame neurologico ed uno studio in angio-risonanza magnetica (RM) post-procedurale a distanza di 3 e 6 mesi dal trattamento.

Risultati

La trombolisi meccanica con sistema Penumbra è stata eseguita in tutti i casi. L’83% dei vasi trattati avevano un valore di 2 su 3 nella scala di trombolisi nell’ictus cerebri (TICI). In 7 pazienti (38,8%) la trombolisi endovenosa non ha avuto successo ed una trombolisi meccanica di salvataggio è stata eseguita. Tre pazienti sono deceduti dopo la procedura (16,7%). In 5 pazienti (27,8%) una procedura di stenting è stata necessaria. In tutti i pazienti abbiamo osservato un significativo miglioramento dei sintomi (NHISS basale medio 19,6±5,6; NHISS post-procedurale medio 7,8±5,5; p<0,0001).

Conclusioni

La nostra esperienza preliminare con il sistema di trombolisi meccanica Penumbra conferma risultati precedentemente riportati, dimostrando la sua efficacia e sicurezza nel trattamento dello stroke acuto dovuto all’occlusione di vasi endocranici di grande calibro.

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italy

    R. Gandini, E. Pampana, C. Del Giudice, F. Massari, S. Spano, E. P. Assako Ondo, E. Salvatori & G. Simonetti

  2. Stroke Unit, Dipartimento di Neuroscienze, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italy

    F. Sallustio, G. Koch & P. Stanzione

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  1. R. Gandini
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  2. E. Pampana
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  3. C. Del Giudice
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  4. F. Massari
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  5. S. Spano
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  6. E. P. Assako Ondo
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  7. E. Salvatori
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  8. F. Sallustio
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  9. G. Koch
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  10. P. Stanzione
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  11. G. Simonetti
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Correspondence to C. Del Giudice.

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Gandini, R., Pampana, E., Del Giudice, C. et al. Acute stroke treatment using the Penumbra endovascular mechanical thrombolysis device: a single-centre experience. Radiol med 117, 1199–1214 (2012). https://doi.org/10.1007/s11547-012-0819-5

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  • DOI: https://doi.org/10.1007/s11547-012-0819-5

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