Penumbra Direct Aspiration System: Removing Clots for Acute Ischemic Stroke

12th Biennial Meeting of the International Andreas Gruentzig Society:  Rio de Janeiro - February 2-6, 2014

From SESSION 6 — Structural

Moderator:  Steve Bailey
Panelists: Kirk Garratt, Gyula Gal, Adam Greenbaum, Nickolas Kipshidze, Brian O’Murchu

Framing the question at hand, what is the state of the current knowledge?

This area has limited data to date. There are only a limited number of stroke centers in the US and Europe centered in larger cities. While thrombus can be extracted in cases in which thrombolysis has failed, the benefit and frequency is poorly characterized.

What are the Gaps in the current knowledge?
We have limited information regarding systematic care. Most patients are treated after CT scan and only a small number undergo invasive therapy. The lack of invasive therapy is multifactorial as there is uncertainty of which specialty should treat the patient and we have limited devices that are available.
The studies to date of embolectomy/thrombectomy are small and not structured to allow comparisons. Concerns remain regarding the complications of direct endovascular therapy.

Our Summary and Recommendations:
Currently, we have insufficient data to recommend thombectomy as the standard of care. It shows promise in a limited number of programs. Centers should be encouraged to develop multidisciplinary stroke teams that respond in the manner of STEMI care.
Trials are warranted that utilize rapid screening such as CT angio and tools to identify patients who are at high risk for cardioembolic events. These patients can be randomized to new device thrombectomy therapy versus standard of care. Operator experience with best in class devices will be needed to avoid the learning curve bias in assessing outcomes.