Purpose: The purpose of this study was to evaluate the safety and efficacy of mechanical thrombectomy with a direct aspiration first-pass technique (ADAPT) using large-bore catheters in patients with acute ischemic stroke due to large vessel occlusion (LVO) in a hospital in Vietnam. Methods: This was a retrospective review of patients with acute ischemic stroke due to LVO who were diagnosed and underwent mechanical thrombectomy using ADAPT with large-bore catheters at Bach Mai Hospital from January 2017 to June 2018. Results: Seventy-three patients (47.9% female; age: 61.29 ± 14.49 years) met study criteria. The average procedure duration was 45.09 ± 38.26 min. Successful recanalization post-ADAPT (thrombolysis in cerebral infarction 2b-3) was achieved in 72.6% (53/73) of patients. Good functional outcome (Modified Rankin Scale 0–2) at 3 months was achieved in 50.7% (37/73), with poor functional outcome in 24.7% (18/73). The 90-day mortality rate was 24.7% (18/73). The hemorrhagic transformation rate was 31.6%, in which 19.2% were symptomatic. Vessel perforation occurred in 5.5% (4/73) of patients but in all cases was associated with the guidewire and not the reperfusion catheter. Vessel dissection occurred in 1.4% (1/73) and vasospasm in 5.5% (4/73) of patients. Conclusion: Mechanical thrombectomy using ADAPT with large-bore catheters for acute ischemic stroke due to LVO is a method that yielded good results in recanalization and clinical recovery in a Vietnamese patient population.

This study reports the initial results of wide-necked bifurcation aneurysms treated with Woven EndoBridge (WEB) system at one of the first centers in Southeast Asia from April 2019 to June 2022. A total of 12 patients (50% female, median age of 66) with 12 aneurysms (9 unruptured and 3 ruptured) were recruited. The aneurysms were located in the basilar apex (4 patients), anterior communicating artery (4 patients), middle cerebral artery (3 patients), and posterior cerebral artery (1 patient). The average aneurysm size was 6.3mm (range 4.8 - 8.0mm) with mean dome to neck ratio of 1.2 and mean neck size of 5.4 mm (range 3.7 - 6.9mm). The technique was successful in all cases (100%) without any adjunctive devices. No intraoperative rupture occurred. Thromboembolic complications that occurred in two patients resulted in death in 1 patient (accompanied by retroperitoneal bleeding) (1/12, 8.3%) and moderate disability in 1 patient (1/12, 8.3%). The MRI follow-up at 3 months showed complete occlusion in 6 aneurysms (6/11, 54.5%) and neck remnant in 5 aneurysms (5/11, 45.5%). The study demonstrated that the WEB system alone was feasible to treat both ruptured and unruptured wide-necked bifurcation aneurysms. This device seems to be a promising tool for the treatment of complex wide-necked bifurcation aneurysms.