Effectiveness of Mechanical Thrombectomy Using the Penumbra System for Acute Ischemic Stroke Due to Large Vessel Occlusion

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Objective: The effectiveness of mechanical thrombectomy using the Penumbra system (PS) for acute ischemic stroke due to large vessel occlusion was evaluated.Subjects: The subjects were 43 patients (mean age: 76.6 years, 24 females) with cerebral infarction who underwent mechanical thrombectomy using the PS between January 2012 and December 2015. Grade 2b or 3 according to the Thrombolysis in Cerebral Infarction (TICI) scale was defined as successful recanalization, and a modified Rankin scale (mRS) score of 0–2 at discharge or 3 months after the onset was defined as a favorable outcome.Results: The median time from stroke onset to hospital arrival was 63 min, time from hospital arrival to the initiation of recombinant tissue plasminogen activator was 61 min, time from stroke onset to recanalization was 263 min, and time from groin puncture to recanalization was 73 min. Successful recanalization was achieved in 62.8%, and favorable outcomes were obtained in 30.2%. Treatment-related complications were observed in 14.0%. The factors predictive of a favorable outcome were Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomographic Score (DWI-ASPECTS) on MRI and time from groin puncture to recanalization, and those predictive of successful recanalization was the time from stroke onset to groin puncture. Concerning the procedure, the time needed for the procedure was shortened, and the recanalization rate was improved, in comparison with before the introduction of ADAPT. Comparison of three generations, i.e., 1st generation, MAX series, and 5MAX-ACE, showed shortening of the time needed for the procedure and improvements in the recanalization rate and outcome with the development of the device.Conclusion: In mechanical thrombectomy using the PS, the extent of ischemia and time needed for the procedure affected the outcome, and upgrades of the device and introduction of ADAPT were suggested to be involved in the improvements in the recanalization rate and outcome.