Abstract T MP5: Primary Aspiration Thrombectomy With the Penumbra Max Catheter System Allows Rapid Recanalization and Cost Efficiency in Acute Stroke Treatment
Introduction: Rapid recanalization remains the goal of acute stroke therapy. Cost effectiveness in stroke treatment is becoming more important. With newer devices such as stentrievers, and improvements upon the older Penumbra aspiration catheters, recanalization rates have improved, but often at the expense of cost containment in stroke treatment.
Hypothesis: We assessed the hypothesis that primary aspiration thrombectomy for endovascular acute stroke treatment with the newer Penumbra Max catheter system can be performed effectively and at a reduced cost as compared to other available devices
Methods: We retrospectively reviewed prospectively collected data in 124 patients who underwent endovascular treatment for acute ischemic stroke at our institution from 1/1/2011 through 6/30/2013. All devices were freely available for use. However, from 1/1/2013 through 6/30/2013, we agreed to use aspiration with the Penumbra Max catheter system as the primary technique for thrombectomy, with other devices, including the Penumbra Separator and Solitaire device, available if primary aspiration failed. Variables evaluated were techniques/devices used, recanalization rates, procedural fluoroscopy times (as a relative marker of recanalization times between techniques), and procedural costs.
Results: Successful recanalization (TICI 2b/3) was achieved in 77% of all cases, with a total ICH rate of 12.1% and sICH of 2.4%. From 1/1/2013 through 6/30/2013 28 patients were treated with primary aspiration using Penumbra Max, with a recanalization rate of 90%. A separator was used in 3 cases and a Solitaire device in 1 patient; with these devices total recanalization was 96%. Primary aspiration using the older Penumbra catheters yielded a recanalization rate of only 59%. Solitaire (n=9) was successful in 70%. TICI 3 recanalization rates were 60% for Penumbra Max, 23% for older Penumbra catheters, and 20% for Solitaire. Average cost/case using the Penumbra Max system was $3243, compared to $5924 as a baseline, yielding a 55% savings. Average fluoroscopy time for Penumbra Max was 22 mins, compared to 36 mins for the older Penumbra catheters and 24 mins for Solitaire.
Conclusions: The Penumbra Max system is clinically and cost effective in stroke thrombectomy.
Author Disclosures: T. Sivapatham: None. J. Lassig: None. J. Goddard: None. M. Madison: Other; Modest; Financial Interest. K. Porth: None. L. Stein: None. A. Castle: None. M. Kolbow: None. S. Hanson: None.
- © 2014 by American Heart Association, Inc.