Endovascular aspiration thrombectomy in acute ischemic stroke therapy: the Penumbra system

Approximately half of acute ischemic stroke patients end up with a disability that interferes with independent living, despite treatment with intravenous tissue plasminogen activator (iv. tPA). One of the strongest explanations is the low rates of full and sustained recanalization at the arterial occlusion site with iv. tPA alone. This prompted the search for adjunctive therapies to achieve recanalization when iv. tPA fails. The Penumbra system is one of only two US FDA-approved devices for use in the endovascular therapy of ischemic stroke. Its design allows it to remove thrombi by a combination of suction and extraction. Studies reporting on this device describe recanalization rates in the range of 80–100%. While these rates are very promising, it is yet to be translated into better functional outcome. Until then, research continues to identify patients who are likely to benefit from recanalization and to get them treated as soon as possible.