A direct aspiration first-pass technique (ADAPT) versus stent retriever for acute ischemic stroke (AIS): a systematic review and meta-analysis

Zhang, Yichi; Zhang, Yue; Hu, Chentao; Zhao, Weisong; Zhang, Zhaohui; Li, Wenqiang

doi:10.1007/s00415-020-10284-w

Cited by 20 publications

(22 citation statements)

References 51 publications

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“…The median number of passes of the present series was 2.0 ± 1.2 which was in line with existing literature (range 1.3–1.9) [ 17 ]. However, the average number of passes increased in the switching strategy subgroup to 2.9 ± 1.2, this evidence was consistent with ASTER trial protocol in which the minimum attempts before switch to another MT technique was three [ 19 , 20 ]. No single clinical parameter was able to predict the switching strategy as shown also by another study [ 17 ]; on the contrary, the diameter of vessels significantly predicted the switching strategy (OR 1.12, CI 95% 1.03–1.22, p = 0.006) and, therefore, a failure of the first-line technique ( Table 2 .).…”

Section: Discussionsupporting

confidence: 82%

Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke

Pampana

Fabiano

Rubeis

et al. 2021

IJERPH

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Background: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. Methods: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. Results: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel’s diameter positively predicted SS result (Odd Ratio [OR] 1.12, Confidence of Interval [CI] 95% 1.03–1.22; p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2–109.0) vs. 40.0 min (CI 95% 35.0–45.2); p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4–387.0) vs. 311.4 min (CI 95% 285.5–338.7); p = 0.23). Conclusion: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel’s diameter positively predicted recourse to SS.

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Section: Discussionsupporting

confidence: 82%

Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke

Pampana

Fabiano

Rubeis

et al. 2021

IJERPH

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“…The results of our study show that there was no significant difference in 90-day all-cause mortality, 90-day mRS scores 0-2, or intracranial haemorrhage between aspiration thrombectomy and stent retriev- er thrombectomy. Although some similar meta-analyses have been reported before our study, they are different in some aspects [24][25][26][27][28][29][30]. Primiani et al [24] reported that aspiration thrombectomy was a safe and effective alternative to primary stent retriever thrombectomy for AIS in a total sample size of 9127 patients, but their included studies did not include all control groups.…”

Section: Discussionsupporting

confidence: 48%

Safety and efficacy of aspiration thrombectomy versus stent retriever thrombectomy for acute ischaemic stroke: a systematic review and meta-analysis.

Hong¹,

Chen²,

Gu³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction:Although aspiration thrombectomy has shown comparable safety and efficacy to stent retriever thrombectomy for acute ischaemic stroke (AIS), the use of aspiration thrombectomy as first-line endovascular treatment for AIS remains controversial. Aim: To perform a systematic evaluation of the safety and efficacy of aspiration thrombectomy versus stent retriever thrombectomy in the treatment of AIS. Material and methods: We searched the online databases PubMed, Embase, Cochrane Library, and SinoMed to collect randomized controlled trials and retrospective studies concerning the treatment of AIS with aspiration thrombectomy and stent retriever thrombectomy. Primary outcomes included 90-day all-cause mortality, a 90-day mRS scores of 0-2, intracranial haemorrhage, and successful recanalization rate. The Jadad scale and the MINORS evaluation items were used to evaluate study quality, and RevMan 5.2 was used to conduct a meta-analysis. Any differential effects in rates between the two strategies were assessed using a random effect model. Results: A total of 15 articles were found, including 2 randomized controlled trials and 13 retrospective studies. It showed that aspiration thrombectomy and stent retriever thrombectomy had similar results in terms of 90-day allcause mortality (p = 0.88), 90-day mRS scores 0-2 (p = 0.29), and intracranial haemorrhage (p = 0.47). And in terms of successful recanalization rates, the aspiration thrombectomy group had better outcomes than the stent retriever thrombectomy group (p = 0.0003). The heterogeneity of 90-day all-cause mortality (I 2 = 0%), 90-day mRS scores of 0-2 (I 2 = 6%), intracranial haemorrhage (I 2 = 21%), and successful recanalization rate (I 2 = 0%) were less than 30%. Conclusions: Both aspiration thrombectomy and stent thrombectomy can be used as the first line of intravascular treatment for AIS.

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“…27 Furthermore, the clinical equality of both approaches was shown in the final rates of early neurological and long-term functional outcome together with mortality at 90-days that did not differ significantly in both groups and were favorable even when considering a worst-case scenario (Table S4). Recent studies found similar results investigating different thrombectomy strategies in LVO stroke, 28,29 but also observed that contact aspiration may be more beneficial about procedural and clinical outcomes in the posterior circulation. 30,31 However, these results seem barley comparable to DMVOs, since most occlusions were proximally located in the basilar artery, and procedural aspects (eg, catheter-tip-clot contact) may be favoring aspiration thrombectomy in this particular large vessel segment.…”

Section: Discussionmentioning

confidence: 66%

Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

Meyer

Stracke

Wallocha

et al. 2022

Stroke

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BACKGROUND: The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation. METHODS: TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events. RESULTS: A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62–81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P =0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P =0.933) and modified Rankin Scale rates (modified Rankin Scale score 0–1, aspiration: 60.5% versus stent retriever 68.6%; P =0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95–0.99]; P <0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16–9.21]; P <0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases. CONCLUSIONS: Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.

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A direct aspiration first-pass technique (ADAPT) versus stent retriever for acute ischemic stroke (AIS): a systematic review and meta-analysis

Cited by 20 publications

References 51 publications

Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke

Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke

Safety and efficacy of aspiration thrombectomy versus stent retriever thrombectomy for acute ischaemic stroke: a systematic review and meta-analysis.

Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

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