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How I treat
The Penumbra Stroke System: a technical review
  1. Albert J Yoo1,
  2. Don Frei2,
  3. Satoshi Tateshima3,
  4. Aquilla S Turk4,
  5. Ferdinand K Hui5,
  6. Allan L Brook6,
  7. Don V Heck7,
  8. Joshua A Hirsch8
  1. 1Department of Interventional and Diagnostic Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
  3. 3Department of Interventional Neuroradiology, UCLA Medical Center, Los Angeles, California, USA
  4. 4Medical University of South Carolina, Charleston, South Carolina, USA
  5. 5Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  6. 6Montefiore Medical Center, Bronx, New York, USA
  7. 7Department of Radiology, Forsyth Medical Center, Winston Salem, North Carolina, USA
  8. 8Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Albert J Yoo, Interventional and Diagnostic Neuroradiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241, Boston, MA 02114 USA; ajyoo{at}


Major ischemic strokes secondary to proximal artery occlusions are responsible for significant morbidity and mortality. Owing to extensive clot burden, these strokes are poorly responsive to intravenous tissue plasminogen activator. The introduction of endovascular therapy, particularly mechanical devices, has resulted in markedly improved recanalization rates of large vessel occlusions. With increasing experience with the Penumbra Stroke System and the 054 reperfusion catheter, there has been further improvement in TIMI 2 and 3 revascularization rates with faster times to vessel opening. The aim of this technical review is to convey various tips and tricks learnt from this experience.

  • Catheter
  • balloon
  • thrombolysis
  • stroke
  • stent
  • stenosis
  • intervention
  • hemorrhage
  • embolic
  • coil
  • brain
  • atherosclerosis
  • angiography
  • aneurysm
  • aneurysm
  • angioplasty
  • arteriovenous malformation
  • flow diverter
  • thrombectomy
  • artery
  • MRI
  • CT
  • vein
  • thrombectomy
  • technique
  • complication

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  • Competing interests AJY receives research support from Penumbra Inc for the Core Imaging Lab for the START trial. DF is a consultant and/or serves on the speakers' bureau for Penumbra, Stryker Neurovascular, Genentech and Codman. AST and DVH are consultants for Penumbra Inc. JAH is a shareholder in Intratech.

  • Provenance and peer review Not commissioned; externally peer reviewed.