Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques

Results-Among the 347 patients (occlusion sites: middle cerebral artery=200, 58%; internal carotid artery Siphon=89, 25%; Tandem=58, 17%), aspiration component led to successful reperfusion (modified thrombolysis in cerebral infarction 2b/3 scores) in 55.6% (193/347 patients), stent retrievers were required in 40%, and a total successful final reperfusion rate of 83% (288/347) was achieved. Overall, procedural complications occurred in 13.3% of patients (48/347). Modified Rankin Scale score of 0 to 2 at 90 days was reported in 45% (144/323). Only 2 factors positively influenced the success of the aspiration component: an isolated middle cerebral artery occlusion (P<0.001) and a shorter time from stroke onset to clot contact (P=0.018). Conclusions-In this large retrospective study, ADAPT was shown to be safe and effective for anterior circulation acute ischemic stroke with a final successful reperfusion achieved in 83%. The site of arterial occlusion and delay of the procedure were predictors for reperfusion. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02523261, NCT02678169, and NCT02466893.

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“…[4][5][6][7][8][9][10][11][12] We aimed to identify patients in whom the aspiration component of ADAPT is most likely to be successful.…”

mentioning

confidence: 99%

Predictors of the Aspiration Component Success of a Direct Aspiration First Pass Technique (ADAPT) for the Endovascular Treatment of Stroke Reperfusion Strategy in Anterior Circulation Acute Stroke

Blanc¹,

Redjem²,

Cicciò³

et al. 2017

Stroke

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“…Based on a tri-axial approach with an 8 Fr guiding catheter (Vista brite Tip®, Johnson & Johnson, New Brunswick, NJ, USA) in the internal carotid artery/6 Fr guiding catheter (Envoy®, Cordis, Fremont, CA, USA) in the VA, stent retrievers were used from the beginning in combination with an aspiration catheter - a distal access catheter (Concentric, Mountain View, CA, USA), a Navien™ catheter (Covidien, Dublin, Ireland), or later a Sofia® catheter (Microvention, Tustin, CA, USA), which was placed distally in the internal carotid artery or VA. The stent retriever was then withdrawn into the aspiration catheter during local aspiration [13,14]. These steps were repeated until the final reperfusion result was reached; the maximum number of attempts was up to the operator and did not exceed 10 in any case in these series.…”

Section: Methodsmentioning

confidence: 99%

Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke

Maus¹,

You²,

Kalkan³

et al. 2017

Cerebrovasc Dis

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Background and Purpose: Cerebral large vessel occlusion (LVO) in acute ischemic stroke (AIS) may be complete (CLVO) or incomplete (ILVO). The influence of ILVO on clinical outcome after mechanical thrombectomy (MT) remains unclear. We investigated primarily the clinical outcome in patients with AIS due to ILVO or CLVO. Methods: Five hundred three consecutive AIS patients with LVO treated with stent-retriever or direct aspiration-based MT between 2010 and 2016 were analyzed. The primary endpoint was favorable clinical outcome (modified Rankin Scale ≤2) at 90 days; secondary endpoints were periprocedural parameters. Results: Forty-nine patients (11.3%) with a median National Institutes of Health Stroke Scale (NIHSS) of 11 presented with ILVO and the remainder presented with CLVO and median NIHSS of 15 (p < 0.001). The median groin puncture-to-reperfusion time was 30 vs. 67 min, respectively (p < 0.001). Successful reperfusion was reached in 47 out of 49 ILVO (95.9%) vs. 298 out of 381 CLVO (78.2%; p < 0.005) with less retrieval maneuvers (1.7 ± 2.2 vs. 3.0 ± 2.5; p < 0.001). The favorable outcome at 90 days was 81% in patients with ILVO vs. 29.1% in CLVO (p < 0.001); respective all-cause mortality rates were 6.4 vs. 28.5% (p < 0.001). Periprocedural complications (6.9%) occurred exclusively in CLVO patients (p < 0.05). ILVO was associated with favorable clinical outcome independent of age and NIHSS in multivariate logistic regression both in the anterior (OR 3.6; 95% CI 1.8-6.9; p < 0.001) and posterior circulation (OR 3.5; 95% CI 1.8-6.9; p < 0.001). Conclusions: AIS due to ILVO is frequent and is associated with a nearly threefold higher chance of favorable clinical outcome at 90 days, independent of age and initial NIHSS compared to CLVO.

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“…The endovascular techniques employed in thrombectomy continue to evolve rapidly and now include the use of multiple clot retrieval devices, balloon guide catheters, and local aspiration catheters [3,4,5]. One technique that has gained significant popularity is direct aspiration thrombectomy (A Direct Aspiration first-Pass Thrombectomy [ADAPT]), wherein a large-bore catheter is navigated directly to the proximal face of the clot, vacuum is applied to the catheter hub, and the clot is then removed by pulling the catheter out while continuing suction [6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of Vacuum Pressures and Forces Generated by Different Catheters and Pumps for Aspiration Thrombectomy in Acute Ischemic Stroke

Froehler¹

2017

Intervent Neurol

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Background: Direct aspiration thrombectomy is an increasingly utilized technique in endovascular stroke treatment that relies on vacuum and suction force to remove the clot. This report assesses the pressures and forces generated by different catheters and pumps. Methods: Vacuum pressures were measured using a vacuum gauge for several catheters (Stryker Catalyst6, Penumbra Ace 064, Medtronic Arc 061, and Penumbra 041) and pumps (Penumbra pump, 60-mL syringe, and the ASPIRE device). Suction forces were calculated based on pressure and catheter tip size (force = area × pressure). Vacuum pressures and forces were also assessed with a coaxial microcatheter (Rebar 18; inner diameter = 0.021 inches), mimicking a combined aspiration and stent retriever approach. Results: All catheters transmitted similar vacuum pressures, but suction force was proportionate to catheter tip area. Pump vacuum pressures were also similar, although the Penumbra pump (mean -25.63 inches Hg [inHg]) was slightly weaker than the syringe and the ASPIRE device (-27.04 and -27.58 inHg, respectively; p < 0.001, two-way ANOVA). A coaxial microcatheter lowered the mean vacuum pressure by only 1.2 inHg (p = 0.005), though it would theoretically create a very significant reduction in suction force if partially blocking the aspiration catheter tip area. Conclusions: All catheters transmit similar vacuum pressure, but the suction force on the clot is stronger with larger catheter tips. Coaxial microcatheters will have a minimal impact on suction force as long as they are proximal to the aspiration catheter tip. Currently available thrombectomy suction devices, including the Penumbra pump, the ASPIRE handheld pump, and the 60-mL syringe, all develop similar vacuum pressures.

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Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques

Abstract: In our cohort, the ADAPT technique was associated with significantly higher good clinical outcomes at 90 days in patients with acute ischemic stroke due to anterior circulation ELVOs treated with mechanical thrombectomy.

Cited by 168 publications

References 25 publications

Predictors of the Aspiration Component Success of a Direct Aspiration First Pass Technique (ADAPT) for the Endovascular Treatment of Stroke Reperfusion Strategy in Anterior Circulation Acute Stroke

Predictors of the Aspiration Component Success of a Direct Aspiration First Pass Technique (ADAPT) for the Endovascular Treatment of Stroke Reperfusion Strategy in Anterior Circulation Acute Stroke

Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke

Comparison of Vacuum Pressures and Forces Generated by Different Catheters and Pumps for Aspiration Thrombectomy in Acute Ischemic Stroke

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