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BACKGROUND AND PURPOSE
The aim of this study was to assess the clinical outcome of patients treated with the Penumbra system (PS) for acute ischemic stroke. A retrospective, monocentric matched-pair analysis in comparison with patients treated by intraarterial thrombolysis (IAT) with alteplase was designed for this purpose.

METHODS
Twenty-two consecutive patients, (mean age 62), with acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) scores ≥ 7 were treated with the PS. Twenty corresponding patients could be identified, treated with IAT. Matches were sought for initial NIHSS score and target vessels. Thrombolysis in myocardial infarction (TIMI) grades, mortality rates, NIHSS upon discharge, and modified Rankin scores (mRs) at 90 days were compared.

RESULTS
A total of 32 vessels in 20 patients were treated in either arm of the study. Recanalization to TIMI 2/3 was successful in 25/32 (78%) of target vessels with the PS, and 17/32 (53%) of target vessels in the IAT group. Upon discharge, 2/20 patients treated with PS and 7/20 patients treated with IAT had a NIHSS score of 0 to 1 or an improvement greater or equal to 10-point on the NIHSS scale. All cause mortality at 90 days was 3/20 patients treated with PS, and 2/20 patients treated with IAT. Three out of twenty patients treated with PS and 7/20 patients treated with IAT had a mRS of ≤ 2 at 90 days.

CONCLUSION
The Penumbra system is effective in re-opening occluded major arteries. Our data seems to indicate that not all patients benefit clinically from improved revascularization of occluded major arteries.