Beruflich Dokumente
Kultur Dokumente
L.N. Hopkins, MD University at Buffalo Neurosurgery Distinguished Professor State University of New York
Keys to Success
Save the Penumbra
Early Dx and TxTime is Brain Medical management: BP, Statins, Antiplatelet, etc Imaging: Brain viability (Go/No Go) Analogy = STEMI (Get the artery OPEN!)
-Minimize risk of intervention
Time Is Brain Save the Penumbra Rapid Reperfusion May Reduce Neurologic Deficit
Reperfusion of the ischemic penumbra may reduce the extent of damage and improve recovery Timing is critical The average patient loses 32,000 brain cells/second
Selection of devices:
Periprocedural care:
Retrospective case reports and case series Prospective single-arm studies (MERCI, Multi-MERCI, Penumbra Pivotal Trial) Randomized trials (SWIFT, TREVO, IMS III)
Merci
Penumbra
Stents
Stentreivers
???
REVIVE
pRESET
Pulse
Separator 3D
ReCOVER
Solitaire - Covidien
CHARACTERISTICS: - CE Mark : AB 2007, FR 2009
3D Penumbra Device
Data from trials vs real-world experience ENRG group data -Early post-market experience with stentretrievers (Solitaire FR) in post-FDA approval era -101 patients from 10 centers throughout the US -A variety of other approaches are used in conjunction with Solitaire FR thrombectomy
Neurosurgery 2012, Mokin et al. Under revision
Stent-retriever
Aspiration catheter
Potential Problem
Embolization to New Territory
1 Solitaire
Retrospective Study. Presented at WFITN, 2011. 2 Trevo 2 Trial. Presented at ESC, 2012.
1. Choosing the right device 2. Choosing the right patient - Common criteria for IA intervention:
NIHSS 8 Onset of symptoms 0-8 hrs
--Q: Should every stroke with large-vessel occlusion be treated with stent-retrievers? - A: No, each stroke case should be analyzed individually. Reperfusion hemorrhage is an issue with large volume deficit
CBV
CBV
Patient 1: has penumbra and Patient 2: has volume loss likely to benefit from intervention (arrow) and no penumbra poor candidate for intervention
- Utilization of CT perfusion imaging for patient selection resulted in improved functional outcomes in the recanalized population. - Outcomes of CT perfusion group were compared to MERCI, Multi-MERCI and the Penumbra trial results.
1 Acre Floorplate
Thank you!
Thank You