Well it’s a new year, and though it may feel like groundhog day most of the time with the ongoing pandemic, medical innovation continues and Interventional Radiology is at the forefront of that innovation.  I personally find it nearly impossible to stay current on all the new products and most IRs can agree that a close relationships with industry reps is important (I would argue crucial) in order to stay current and help decide what may be best to help our patients.  I had a chance to sit down (yes we sat down together and had lunch!) one of the first reps I met when I moved back to Saskatoon.  Mike Remo is an Associate Territory Manager-Vascular, Western Canada for Penumbra, Inc. and a great person to have lunch with.

CAIR: Hey Mike, thanks for taking the time to talk to us.  As we enter a new year, what devices/equipment are you most excited about from Penumbra in 2022 and why? 

MR: That’s truly a difficult question. I am so fortunate to have an amazing portfolio in Thrombectomy and Embolization in both the Neuro and Peripheral vascular space. The innovation pipeline is rich and ever changing so I feel like I am in constant “launch mode” with Penumbra.

I must say that our Lightning Technology from our Thrombectomy line is what gets me most excited. There is nothing on the market like our Intelligent Aspiration. Lightning Technology coupled with our State-of-the-Art Aspiration catheters allows interventionalist from various specialties such as Vascular Surgeons, Interventional Radiologists and Interventional Cardiologists to treat clot burden, from both the arterial and venous systems safely and effectively with little to no use of TPA in single sessions. This benefits the physician, their patients and keeps patients out of ICU’s, while vastly reducing the bleeding risks.  This technology is used with our proprietary Engine Pump that creates near perfect vacuum and has a very efficient streamlined set up which is key in acute settings.

Secondly, our Ruby Coils for embolization are incredible. They do not rely on fibers for Thrombogenesis but Penumbra platinum coils mechanically embolize target vessels thanks to their very dense packing. Ruby coils are unique as they are extremely soft, high volume and have long lengths (60cm) and are fully retractable. This is important as less coils will be used in each case. This is better for the patient, less exposure to radiation, shorter procedure times and is cost effective for the healthcare facility. The different product families allow for versatility for various case types.

CAIR: I haven’t had a chance to try out your thrombectomy line yet, but I am hoping to soon, and I will concure that those Ruby coils are very soft and easy to pack! How do these technological advances impact patient care?

MR: The innovation from Penumbra always has the patient in mind first! Penumbrians collectively make it a mission every day to partner with our physicians to ensure our medical devices are used appropriately for the right patient to better their outcomes. Thus provide the best potential outcomes and quality of life for Canadians.

We all know how this current COVID-19 Global Pandemic has negatively impacted our health care system. One of the greatest concerns is running out of ICU beds in our health care facilities. The system is emergently flooded with patients that have clot burden, a known side effect of Covid. It could be stroke, myocardial infarction, DVT or Pulmonary Embolism. One of the main treatment options is the use of TPA which we know is associated with a high bleeding risk and requires a team to monitor these patients over a few days in the ICU. This negatively impacts an already tired medical team let alone the valuable ICU bed.

Our Penumbra Indigo mechanical thrombectomy  device is a great option for all the disease states I mentioned earlier. It is effective, safe, and easy to use. The Lighting Technology available with our newly approved CAT7, CAT 8 and CAT12 aspiration catheters in Canada help mitigate blood loss intra-operatively while the new sizes and design allow for excellent tracking. These newly approved products also now carry the indication for use in PE, which is especially exciting given the lack of tools available up to this point and the current desire to develop effective PERT teams. Most importantly for the patient is single session, little to no TPA use and can keep them out of the ICU. The procedures are endovascular therefore they are less invasive vs surgical options.

As for our embolization Ruby Platform, the mechanism of action for creating a  mechanical occlusion has shown to provide lower recanalization rates vs the fibered counterparts that rely on thrombogenis for occlusion. This is important because recanalization means bringing the patient back for further care. Retractable coils like Ruby allow for better control in the procedure which is safer for patients as well.

CAIR: You are correct that we are all trying to find ways to keep patients out of the ICU, we got pretty creative in Saskatchewan with our thrombolysis patients particularly during a time when we were sending ICU patients to Ontario because we had no ICU capacity (quick shout out to any IRs in Ontario who helped treat the patients sent from Saskatchewan, thank you). Mike, how does Penumbra support IRs hoping to learn more about this? 

MR: Educating in this pandemic at the end of 2020  was a challenge! Fortunately, most hospitals that were locked down at this time had a virtual option such as ZOOM for education. Fast-forward to today and we are still in a pandemic but we are starting to see some normalcy in what I typically do.

My passion is to partner with my IR’s and present them options that will help them in their procedures, in turn providing better care for their patients. Each IR’s needs are different, and I like to tailor my support for their needs. I take pride in what I do and support my partners through face-to-face meetings, in-services for the entire team that are essential to get a hands-on understanding of how our devices work and troubleshooting tips. I take my support seriously therefore I am available 24-7 for case support. I even have my home number on my voicemail if there happens to be a time I miss a call on my mobile. In my absence my teammates across Canada are also available for case support. We further support cases by bringing our own medical device stock for hospitals that currently do not have our devices or consignment.

Last, we provide on going webinars, host PEER meetings, attend all the critical conferences where our IR’s may be, and communicate and support the latest relevant clinical studies. We always include educating Fellows to ensure they have the most current information about Penumbra devices and have the opportunity to learn beyond the doors of the hospital, so they remain on the cutting edge and can receive a global perspective.

Mike Remo is an industry professional with almost 20 years of experience beginning his career in Pharmaceuticals and quickly transitioned to Medical Devices.

His passion for medical innovation and being a clinical consultant is what brought him to Cook Medical and specialized in Aortic Intervention (EVAR/TEVAR). This allowed him to create relationships with Cardiac/Vascular Surgeons and Interventional Radiologists around the country. His business acumen led him to the Medical Start up Ascyrus Medical which had developed an Ascending Dissection Stent (AMDS) to treat Type 1a Dissections. The success of this team to penetrate the market let to the sale of their company to CryoLife Inc. (Artivion) in 2020.

Today, Mike consults for Penumbra Inc., a leader in Thrombectomy (Indigo) and Embolization (Ruby). Mike has developed many friendships with his physicians and is considered an essential partner to help with patient care.

Mike is based out of Winnipeg, Manitoba with his lovely wife Candess and daughter Pepper who also has an interest in Medicine when she graduates in 2024.

Contact info: mremo@penumbrainc.com  | 431-996-9000

*This content was created by CAIR editors on behalf of Penumbra as a CAIR industry partners.  CAIR makes no claims, promises, or guarantees about the accuracy, completeness, or adequacy of the content, and expressly disclaims liability for errors and omissions in the contents of this article. Reference to any specific commercial product, process, or service, or the use of any trade, firm or corporation name is for the information and convenience of the public, and does not constitute endorsement, recommendation, or favoring by the CAIR.