The direct first pass aspiration technique in the treatment of acute ischemic stroke resulting from large vessel occlusions

ABSTRACT

Mechanical thrombectomy using stent retrievers is the standard treatment for acute ischemic stroke that results from large vessel occlusions. The direct aspiration first pass technique (ADAPT) has been proposed as an efficient, fast, and cost-effective thrombectomy strategy. The aim of this study was to assess the safety and efficacy of ADAPT.

Methods

Recanalization was assessed using the modified thrombolysis in cerebral infarction (mTICI) score. Neurological outcomes were assessed using the National Institutes of Health Stroke Scale and modified Rankin Scale.

Results

Fifteen patients were evaluated. The mTICI score was 2b-3 in 80%, and it was 3 in 60% of patients. No intracranial hemorrhage was seen. At three months, modified Rankin Scale scores ≤ 2 were observed in 60% of patients and the mortality rate was 13.3%.

Conclusions

The ADAPT appears to be a safe, effective, and fast recanalization strategy for treatment of acute ischemic stroke resulting from large vessel occlusions.

RESUMO

A trombectomia mecânica com stent retrievers é o tratamento padrão ouro do acidente vascular cerebral isquêmico agudo (AVCi) por oclusão de grandes artérias. A técnica de aspiração primária (ADAPT) tem sido proposta como uma estratégia de trombectomia rápida e com boa custo-efetividade. O objetivo deste estudo foi avaliar a segurança e eficácia da técnica ADAPT.

Métodos

A recanalização foi avaliada utilizando a escala mTICI. Os desfechos neurológicos foram avaliados utilizando as escalas do NIHSS e mRS.

Resultados

Quinze pacientes foram avaliados. Foram obtidas taxas de mTICI = 2b-3 em 80% e TICI = 3 em 60% dos pacientes. Não ocorreram hemorragias intracranianas. Em 3 meses as taxas de mRS≤2 e mortalidade foram respectivamente 60% e 13.3%.

Conclusão

A técnica ADAPT parece ser uma estratégia de recanalização rápida, segura e efetiva para o tratamento do AVC por oclusão de grandes artérias.

stroke - stents - catheters

acidente vascular cerebral - stents - cateteres

• References

• 1 Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-35. https://doi.org/10.1161/STR.20170059201700590074
• 2 Goyal M, Menon BK, Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-31. https://doi.org/10.1016/S0140-6736(16)00163-X
• 3 Campbell BC, Hill MD, Rubiera M, Menon BK, Demchuk A, Donnan GA et al. Safety and efficacy of solitaire stent thrombectomy: individual patient data meta-analysis of randomized trials. Stroke. 2016;47(3):798-806. https://doi.org/10.1161/STROKEAHA.115.012360
• 4 Turk AS, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D, et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. 2014;6(3):231-7. https://doi.org/10.1136/neurintsurg-2013-010713
• 5 John S, Hussain MS, Toth G, Bain M, Uchino K, Hui FK. Initial experience using the 5MAX™ ACE reperfusion catheter in intra-arterial therapy for acute ischemic stroke. J Cerebrovasc Endovasc Neurosurg. 2014;16(4):350-7. https://doi.org/10.7461/jcen.2014.16.4.350
• 6 Stampfl S, Kabbasch C, Muller M, Mpotsaris A, Brockmann M, Liebig T et al. Initial experience with a new distal intermediate and aspiration catheter in the treatment of acute ischemic stroke: clinical safety and efficacy. J Neurointerv Surg. 2016;8(7):714-8. https://doi.org/10.1136/neurintsurg-2015-011801.
• 7 Jankowitz B, Grandhi R, Horev A, Aghaebrahim A, Jadhav A, Linares G et al. Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: safety, feasibility and outcomes in 112 consecutive patients. J Neurointerv Surg. 2015;7(1):27-31. https://doi.org/10.1136/neurintsurg-2013-011024
• 8 Comai A, Haglmüller T, Ferro F, Dall’Ora E, Currò Dossi R, Bonatti G. Sequential endovascular thrombectomy approach (SETA) to acute ischemic stroke: preliminary single-centre results and cost analysis. Radiol Med (Torino). 2015;120(7):655-61. https://doi.org/10.1007/s11547-015-0501-9
• 9 Delgado Almandoz JE, Kayan Y, Young ML, Fease JL, Scholz JM, Milner AM et al. Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg. 2015;8(11):1123-8. http://dx.doi.org/10.1136/neurintsurg-2015-012122
• 10 Romano DG, Cioni S, Vinci SL, Pero G, Comelli C, Comai A et al.. Thromboaspiration technique as first approach for approach for endovascular treatment of acute ischemic stroke: initial experience at nine Italian stroke centers. J Neurointerv Surg. 2017;9(1):6-10. https://doi.org/10.1136/neurintsurg-2016-012298
• 11 Kowoll A, Weber A, Mpotsaris A, Behme D, Weber W. Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center. J Neurointerv Surg. 2016;8(3):230-4. https://doi.org/10.1136/neurintsurg-2014-011520
• 12 Vargas J, Spiotta A, Fargen K, Turner R, Chaudry I, Turk A. Long term experience using the ADAPT technique for the treatment of acute ischemic stroke. NeuroIntervent Surg. 2016;pii: neurintsurg-2015-012211. https://doi.org/10.1136/neurintsurg-2015-012211
• 13 Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-29. https://doi.org/10.1056/NEJMoa0804656
• 14 The National Institute of Neurological Disorders and Stroke, rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-7. https://doi.org/10.1056/NEJM199512143332401
• 15 Humphries W, Hoit D, Doss VT, Elijovich L, Frei D, Loy D et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg. 2015;7(2):90-4. https://doi.org/10.1136/neurintsurg-2013-010986
• 16 Massari F, Henninger N, Lozano JD, Patel A, Kuhn AL, Howk M et al. ARTS (Aspiration-Retriever Technique for Stroke): initial clinical experience. Interv Neuroradiol. 2016;22(3):325-32. https://doi.org/10.1177/1591019916632369
• 17 Turk AS, Turner R, Spiotta A, Vargas J, Holmstedt C, Ozark S et al. Comparison of endovascular treatment approaches for acute ischemic stroke: cost effectiveness, technical success, and clinical outcomes. J Neurointerv Surg. 2015;7(9):666-70. https://doi.org/10.1136/neurintsurg-2014-011282
• 18 Son S, Choi DS, Oh MK, Hong J, Kim SK, Kang H et al. Comparison of Solitaire thrombectomy and Penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion. J Neurointerv Surg. 2016;8(1):13-8. https://doi.org/10.1136/neurintsurg-2014-011472
• 19 Mokin M, Sonig A, Sivakanthan S, Ren Z, Elijovich L, Arthur A et al. Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes. Stroke. 2016;47(3):782-8. https://doi.org/10.1161/STROKEAHA.115.011598
• 20 Goyal M, Fargen KM, Turk AS, Mocco J, Liebeskind DS, Frei D et al. 2C or not 2C: defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials. J Neurointerv Surg. 2014;6(2):83-6. https://doi.org/10.1136/neurintsurg-2013-010665