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'Vacuum' Device Is a Clot Buster

New Treatment Could Help Stroke Patients When Standard Treatment Fails
By
WebMD Health News
Reviewed by Louise Chang, MD

Feb. 22, 2008 (New Orleans) -- A tiny vacuum-cleaner-like device can help stroke patients when standard clot-busting drugs fail, researchers report.

Called Penumbra, the recently approved device suctions out clots that can cause an ischemic stroke.

The most common type of stroke, ischemic stroke occurs when blood flow to an area of the brain is compromised by a blood clot. This leads to the death of brain cells and brain damage.

Penumbra restored blood flow in 82% of 125 patients studied, says Cameron McDougall, MD, chief of endovascular neurosurgery at the Barrow Neurological Institute in Phoenix.

"There were no serious adverse events associated with the procedure, and nearly 60% of patients were better neurologically by the time they left the hospital," he tells WebMD.

Also, one in four patients had no to minimal disability three months later.

The findings were presented at the American Stroke Association's (ASA) International Stroke Conference.

Penumbra Helps When tPA Fails

About 780,000 Americans suffer a stroke each year and more than 150,000 of them die. Survivors often face serious disability.

For patients who suffer an ischemic stroke, tissue plasminogen activator, or tPA, can mean the difference between permanent brain damage and a return to normal activities. TPA breaks up the clot, restoring blood flow to the brain.

But tPA has to be administered in the first three hours after symptoms strike, and the vast majority of people fail to get to the hospital in time. Plus, it only works in about 40% of patients who get it.

Penumbra could help both these groups of people, McDougall says.

A catheter is inserted through a small puncture in the groin. Under X-ray guidance, it is advanced through the blood vessels until it reaches the closest edge of the blockage. A wire is advanced to dislodge the clot, which is sucked into the catheter.

McDougall says that originally, the system had a plan B -- a clot-grabbing device that doctors could use if the vacuum failed. "But we never really needed it," he says.

Not everyone benefited from the new device. By three months after the procedure, about one in three of the patients had died, many due to bleeding in the brain.

Given the severity of their illness, "this was not an unexpected result," says Philip Gorelick, MD, head of the committee that chose which studies would be presented at the meeting and chairman of neurology at the University of Illinois in Chicago.

They "had ischemic stroke that was pretty severe for a clinical trial," he tells WebMD.

Penumbra isn't the only clot-dislodging device. Doctors can also use a corkscrew-shaped wire called the Merci Retriever to pull out clots.

According to McDougall, the two devices compare "favorably." But the only way to really know is to pit one against the other in a clinical trial, Gorelick says.

The new study was sponsored by Penumbra Inc.

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