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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(07): 412-418
DOI: 10.1590/0004-282X20170059
ARTICLES

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

Técnica de aspiração primária no tratamento do acidente vascular cerebral isquêmico por oclusões de grandes vasos
Luís Henrique de Castro-Afonso
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirão Preto SP, Brasil;
,
Guilherme Seizem Nakiri
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirão Preto SP, Brasil;
,
Lucas Moretti Monsignore
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirão Preto SP, Brasil;
,
Pedro Telles Cougo-Pinto
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurologia, Ribeirão Preto SP, Brasil.
,
Francisco Antunes Dias
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurologia, Ribeirão Preto SP, Brasil.
,
Frederico Aléssio-Alves
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurologia, Ribeirão Preto SP, Brasil.
,
Octávio Marques Pontes-Neto
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurologia, Ribeirão Preto SP, Brasil.
,
Daniel Giansante Abud
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista, Ribeirão Preto SP, Brasil;
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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


Publikationsverlauf

Eingereicht: 12. Juli 2016

Angenommen: 20. Dezember 2016

Artikel online veröffentlicht:
05. September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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