9. Penumbra system
• CE and FDA certificated
• Indication for use (501k document)
• Revasculization of patients with acute
ischemic stroke secondary to
intracranial large vessel occlusive
disease within 8 hours of symptom
onset
10. System Components
• Reperfusion Catheter
– Optimized design for efficient navigation and aspiration
• Separator™
– Operator controlled movement clears Reperfusion Catheter
enabling continuous aspiration.
• Penumbra Aspiration Pump & Aspiration Tubing
– Provides continuous, physiologic vacuum that can be controlled
from the sterile field.
10 1274.C
12. Aspiration System
Matched 041
Separator™
Reperfusion
Catheter 041
Matched 032
Separator
Reperfusion
Catheter 032
Matched 026
Separator
The Penumbra System uses a unique Microcatheter and Separator™
Reperfusion debulking approach to intracranial revascularization.
based thrombus
Catheterwith the Penumbra Aspiration Pump and Accessories, its
Together 026
advantages include:
• Proximal working position 11 1274.C
• Continuous aspiration
13.
14. Budapest Case #3: Exchanged Devices
• 041 Reperfusion
Catheter tracked
into Temporal
branch
• Became clogged
• Removed Separator 041 Separator bulb
• Temporal branch
opened
13 1274.C
15. Budapest Case #3: Exchanged Devices
• 041 Reperfusion
Catheter tracked
into Temporal
branch
• Became clogged
• Removed Separator 041 Separator bulb
• Temporal branch
opened
13 1274.C
16. Patient # 74: Baseline
• 67 year old female
• Baseline NIHSS: 8
despite right MCA M1
segment occlusion.
• Good collateral flow
and preservation of
lenticulo striates
• 7 hrs 10 min from
onset to arterial
puncture
14 1274.C
17. Patient # 74: Post-Penumbra
• 041 Reperfusion
Catheter and 041
Separator X2 restored
flow to distal vascular
bed.
• 38 min revasc. time
• Discharge NIHSS: 0
• 90 Day NIHSS: 0
• 90 Day mRS: 0
• Excellent recovery
despite late time to
arterial puncture.
15 1274.C
18. Patient # 34: Baseline
• 70 year old female
• History of Afib.
• Baseline NIHSS: 14
despite left MCA
superior M2 segment
occlusion with intact
lenticulo striates.
• 4 hrs 5 min from onset
to arterial puncture
16 1274.C
19. Patient # 34: Post-Penumbra
• 026 Reperfusion
Catheter and 026
Separators X3
efficiently opened
small, tortuous M2
• 21 min revasc. time
• Discharge NIHSS: 0
• 90 Day NIHSS: 0
• 90 Day mRS: 0
17 1274.C
20. Patient # 37: Baseline
• 60 year old male
• Baseline NIHSS: 12
despite left ACA A3
occlusion
• 5 hrs 20 min from
onset to arterial
puncture
18 1274.C
21. Patient # 37: Post-Penumbra
• Flow restored
• 32 min revasc. time
• 026 system reached
A3 segment safely
• Discharge NIHSS: 1
• 90 Day NIHSS: 1
• 90 Day mRS: 1
• Excellent recovery
indicates treatment of
A3 occlusion was
warranted
19 1274.C
48. What’s different from
surgery
• From inside the vessels
• blood flowing
• blood clotting
• every vessel is reachable (sort of)
49. You need to?
• learn
• handle X-ray equipments
• complete cerebrovascular anatomy
• setting up the system
• different catheter, wires, stent, coils...
50. Taiwan
• Neuroradiology
• Handle X-ray equipment
• Have techniques in angiography
• Access to all image modality
• Pioneer in this field in Taiwan
51. Taiwan
• Neuroradiology
• no patient care experience
• need neurosurgeons backup
• more conservative
• low income from treatment
55. Taiwan
• Neurosurgeon
• We have patients
• Know more of these diseases
• More aggressive
• More treatment choices
• Can negotiate the “insurance issue”
56. We can now
• Perform all interventional procedure
• Use most catheters, wires, balloons
• Use ordinary coils, embolizers
• Use any stuffs not cover by
57. We can not
• Apply
• Detachable coils ( )
• Carotid stent ( )
