Treatment of acute cerebral artery occlusion using the Penumbra system: our early experience
| Autor: | Masanobu Okauchi, Masahiko Kawanishi, Takashi Tamiya, Kenya Kawakita, Naohiro Osaka, Atsushi Shindo, Nobuyuki Kawai, Naoki Hayashi |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Catheters medicine.medical_treatment Neuroimaging Suction Severity of Illness Index recanalization Quality of life Occlusion ischemic stroke Medicine Humans Thrombolytic Therapy Aged Retrospective Studies Thrombectomy Aged 80 and over Salvage Therapy Clinical Trials as Topic Rehabilitation business.industry Cerebral infarction Penumbra Contraindications Thrombolysis Cerebral Infarction Equipment Design Penumbra system Middle Aged medicine.disease Recombinant Proteins Surgery Catheter Treatment Outcome Tissue Plasminogen Activator Ischemic stroke Acute Disease Reperfusion Quality of Life Brain Damage Chronic Female Original Article Neurology (clinical) business clot retrieval |
| Zdroj: | Neurologia medico-chirurgica |
| ISSN: | 1349-8029 |
| Popis: | Intravenous recombinant tissue-type plasminogen activator (rt-PA) therapy is highly recommended to patients who are diagnosed with ischemic stroke within 4.5 hours after the onset while mechanical clot retrieval can be attempted in patients who are not indicated for or cannot effectively receive intravenous rt-PA therapy. In this article, we report early treatment outcomes and discuss the usefulness of mechanical clot retrieval using the Penumbra system (Penumbra Inc., Alameda, California, USA), especially in terms of technical cautions during the procedure and adaptability to elderly and high National Institutes of Health Stroke Scale (NIHSS) patients. We included 7 patients with thromboembolic occlusion. Pre-treatment NIHSS score ranged from 11 to 36 (mean: 24.9). All patients achieved good recanalization [thrombolysis in cerebral infarction (TICI) grade 2a or greater] without complications. The NIHSS score at 30 days after the treatment ranged between 0 and 28 (mean: 12.4), and improved more than 10 points in 4 of the 7 patients (57.1%). To obtain good recanalization without complications, selection of suitable reperfusion catheter and careful manipulation of separator prefiguring the occluded distal vessels are essential. The improved NIHSS score at 30 days after the treatment may have led to favorable results, such as an increased participation in available rehabilitation programs and the alleviation of the burden of care. Our findings suggest that the Penumbra system might be effective for treatment in elderly patients or patients with high NIHSS score wherein rt-PA therapy is inadvisable or ineffective in ischemic stroke secondary to large vessel occlusion. Recanalization can improve their quality of life on condition that the procedure is performed successfully without serious complications. |
| Databáze: | OpenAIRE |
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