European Radiology

, Volume 19, Issue 9, pp 2286–2293 | Cite as

Penumbra Stroke System as an “add-on” for the treatment of large vessel occlusive disease following thrombolysis: first results

  • Tobias Struffert
  • Martin Köhrmann
  • Tobias Engelhorn
  • Tim Nowe
  • Gregor Richter
  • Peter D. Schellinger
  • Stefan Schwab
  • Arnd Doerfler


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.


Mechanical recanalisation Penumbra Stroke System Stroke Flat-detector computed tomography 


  1. 1.
    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):1581–1587CrossRefGoogle Scholar
  2. 2.
    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 353:2036–2037PubMedCrossRefGoogle Scholar
  3. 3.
    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 351:2170–2178PubMedCrossRefGoogle Scholar
  4. 4.
    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 16:1977–1986PubMedGoogle Scholar
  5. 5.
    Brandt T, von Kummer R, Muller-Kuppers M, Hacke W (1996) Thrombolytic therapy of acute basilar artery occlusion. Stroke 27:875–881PubMedGoogle Scholar
  6. 6.
    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):1160–1165PubMedCrossRefGoogle Scholar
  7. 7.
    US Food and Drug Administration (2004) FDA Neurological Devices Panel fifteenth meeting. Accessed 6 Nov 2006
  8. 8.
    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):1409–1413PubMedCrossRefGoogle Scholar
  9. 9.
    Köhrmann M, Jüttler E, Huttner HB, Schellinger PD (2007) Thrombolysis for ischemic stroke: an update. Nervenarzt 78(4):393–495PubMedCrossRefGoogle Scholar
  10. 10.
    Kalender WA, Kyriakou Y (2007) Flat-detector computed tomography (FD-CT). Eur Radiol 17:2767–2779PubMedCrossRefGoogle Scholar
  11. 11.
    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 57:1603–1610PubMedGoogle Scholar
  12. 12.
    Thrombolysis in myocardial infarction (TIMI) trial (1985) Phase 1 findings—TIMI study group. N Engl J Med 312:932–9336Google Scholar
  13. 13.
    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 30:2598–2605PubMedGoogle Scholar
  14. 14.
    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):876–881PubMedCrossRefGoogle Scholar
  15. 15.
    Wildenhain SL, Jungreis CA, Barr J, Mathis J, Wechsler L, Horton JA (1994) CT after intracranial intraarterial thrombolysis for acute stroke. AJNR 15:487–492PubMedGoogle Scholar
  16. 16.
    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 27:2048–2052PubMedGoogle Scholar
  17. 17.
    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):11–21CrossRefGoogle Scholar
  18. 18.
    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 274:1017–1025CrossRefGoogle Scholar
  19. 19.
    Heran NS, Song JK, Namba K, Smith W, Niimi Y, Berenstein A (2006) The utility of DynaCT in neuroendovascular procedures. Am J Neuroradiol 27:330–332PubMedGoogle Scholar
  20. 20.
    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):517–523PubMedCrossRefGoogle Scholar
  21. 21.
    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):1581–1584PubMedCrossRefGoogle Scholar
  22. 22.
    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 PubMedGoogle Scholar
  23. 23.
    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 36:1432–1438PubMedCrossRefGoogle Scholar
  24. 24.
    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 282:2003–2011PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Tobias Struffert
    • 1
  • Martin Köhrmann
    • 2
  • Tobias Engelhorn
    • 1
  • Tim Nowe
    • 2
  • Gregor Richter
    • 1
  • Peter D. Schellinger
    • 2
  • Stefan Schwab
    • 2
  • Arnd Doerfler
    • 1
  1. 1.Department of NeuroradiologyUniversity of Erlangen-NurembergErlangenGermany
  2. 2.Department of NeurologyUniversity of Erlangen-NurembergErlangenGermany

Personalised recommendations