Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy

Turk, Aquilla S; Spiotta, A; Frei, Don; Mocco, J; Baxter, Blaise; Fiorella, David; Siddiqui, Adnan H.; Mokin, Maxim; Dewan, Michael C.; Woo, Henry H.; Turner, Raymond D; Hawk, Harris; Miranpuri, Amrendra; Chaudry, Imran

doi:10.1136/neurintsurg-2013-010713.rep

Cited by 169 publications

(107 citation statements)

References 19 publications

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“…Approximately half of the patients (49%) received intraprocedural GP/IIbIIIa inhibitors. Stentrievers were used for intracranial thrombectomy in 71% of the patients, while 29% were either treated with pre-stentriever era devices (MERCI, Penumbra) or with thromboaspiration alone using the ADAPT technique [20] . Reperfusion was successful (mTICI 2B/3) in 88% of the cases and was complete (TICI 3) in 40%.…”

Section: Resultsmentioning

confidence: 99%

Endovascular Treatment of Acute Ischemic Stroke Due to Tandem Occlusions: Large Multicenter Series and Systematic Review

Grigoryan

Haussen

Hassan³

et al. 2016

Cerebrovasc Dis

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Background: Ischemic strokes due to tandem occlusions (TOs) have poor outcomes if they have been treated with only medical interventions. Recent trials demonstrated the effectiveness of endovascular treatment of acute ischemic stroke due to intracranial occlusions; however, most studies excluded patients with TOs. Methods: Retrospective review of prospectively collected thrombectomy databases from 3 stroke centers between 2011 and 2015. Consecutive patients with tandem extracranial steno-occlusive carotid disease and intracranial occlusions who underwent emergent thrombectomy were selected. Angiographic and clinical outcomes were analyzed; baseline and procedural variables were included in univariate and multivariate analyses to define the independent predictors of good outcomes (90-day modified Rankin Scale ≤2). Results: A total of 100 patients met the study inclusion criteria. The mean age was 64.4 ± 12.5, baseline National Institutes of Health Stroke Scale (NIHSS) 17.6 ± 5.0, time from last known well to puncture 7.3 ± 5.8 h, and Alberta Stroke Program Early CT Score (ASPECTS) 7.5 ± 1.6. Forty percent received intravenous tissue plasminogen activator. Intracranial occlusion sites included: internal carotid artery thrombus, 31%; middle cerebral artery (MCA)-M1, 53%; MCA-M2, 10%; and anterior cerebral artery, 6%. Good outcome was achieved in 42% and successful reperfusion modified thrombolysis in cerebral infarction (mTICI ≥2B) in 88% of the cases, including complete (mTICI 3) reperfusion in 40%. Severe parenchymal hematoma (PH)-2 occurred in 6% of the patients and 90-day mortality was 20%. In the multivariate analysis, younger age (OR 0.93; 95% CI 0.88-0.98; p = 0.004), lower baseline NIHSS (OR 0.84; 95% CI 0.74-0.94; p = 0.003), higher ASPECTS (OR 1.50; 95% CI 1.02-2.19; p = 0.038), and mTICI 3 reperfusion (OR 3.56; 95% CI 1.18-10.76; p = 0.024) were independent predictors of good outcome at 90 days. Conclusions: Acute endovascular treatment of tandem anterior circulation occlusions yields good outcomes and has similar outcome predictors to isolated intracranial occlusions. Given their comparable clinical behavior, these patients should be included in future trials.

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Section: Resultsmentioning

confidence: 99%

Endovascular Treatment of Acute Ischemic Stroke Due to Tandem Occlusions: Large Multicenter Series and Systematic Review

Grigoryan

Haussen

Hassan³

et al. 2016

Cerebrovasc Dis

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“…Aspiration thrombectomy has developed an important role in acute ischemic stroke intervention and, as a part of A Direct Aspiration First Pass Technique (ADAPT), is an effective first-line therapy. 50,51 The ADAPT method, which focuses on engaging the thrombus and removing it entirely intact, differs from previous techniques that used a separator wire to disrupt the thrombus at the tip of the catheter lumen. 50 Furthermore, distal aspiration through intermediate catheters, in conjunction with stent retrievers, has been shown to reduce procedure times and decrease the number of passes needed for reperfusion.…”

Section: Aspiration Devicesmentioning

confidence: 99%

“…50,51 The ADAPT method, which focuses on engaging the thrombus and removing it entirely intact, differs from previous techniques that used a separator wire to disrupt the thrombus at the tip of the catheter lumen. 50 Furthermore, distal aspiration through intermediate catheters, in conjunction with stent retrievers, has been shown to reduce procedure times and decrease the number of passes needed for reperfusion. 23 Balloon guide catheters can be used to halt anterograde blood flow in the affected vascular territory and serve to reduce distal embolization during thrombectomy attempts, although their utility is currently debated.…”

Section: Aspiration Devicesmentioning

confidence: 99%

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Novel and emerging technologies for endovascular thrombectomy

Chartrain

Awad

Shoirah

et al. 2017

FOC

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Endovascular thrombectomy device improvements in recent years have served a pivotal role in improving the success and safety of the thrombectomy procedure. As the intervention gains widespread use, developers have focused on maximizing the reperfusion rates and reducing procedural complications associated with these devices. This has led to a boom in device development. This review will cover novel and emerging technologies developed for endovascular thrombectomy.

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“…1,2) Moreover, five randomized controlled trials (RCTs) demonstrated the usefulness of mechanical thrombectomy. 1,[3][4][5][6][7] However, some patients with atherothrombotic brain infarction accompanied by stenosis of major intracranial arteries require percutaneous transluminal angioplasty (PTA) or stent placement for severe residual stenosis or reocclusion after mechanical thrombectomy and are difficult to treat.…”

Section: Introductionmentioning

confidence: 99%

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

Kakumoto

Sankoda

Kin

et al. 2018

JNET

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Objective: While intracranial mechanical thrombectomy has been established as a treatment, atherothrombotic brain infarction due to stenosis of major cerebral arteries is occasionally difficult to treat as severe stenosis persists after recanalization, eventually requiring percutaneous transluminal angioplasty (PTA) or stent placement. The contents and results of mechanical thrombectomy for atherothrombotic brain infarction that we have encountered are presented. Methods:The subjects were 17 patients diagnosed with atherothrombotic brain infarction among the 99 patients with cerebral infarction accompanied by major intracranial artery occlusion treated at our hospital during the 30 months from January 2014 and June 2016. Recanalization graded as Thrombolysis in Cerebral Infarction (TICI) 2b or higher was regarded as effective, and the outcome was evaluated using the modified Rankin Scale (mRS). Results:The responsible lesion was located at the origin of the internal carotid artery (ICA) in three patients, in the ICA siphon in four patients, middle cerebral artery (MCA) in five patients, vertebral artery (VA) in two patients, and basilar artery (BA) in three patients. Effective recanalization was achieved in 82.4%, the mRS score was 0-2 in 52.9%, and the postoperative mRS score was the same as before treatment in 11.8%. Conclusion:The outcome of intracranial mechanical thrombectomy for atherothrombotic brain infarction accompanied by major intracranial artery stenosis was favorable in many patients, and aggressive treatment is considered recommendable. In addition, safe and appropriate execution of additional treatments for residual stenotic lesions leads to favorable outcomes.

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Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy

Cited by 169 publications

References 19 publications

Endovascular Treatment of Acute Ischemic Stroke Due to Tandem Occlusions: Large Multicenter Series and Systematic Review

Endovascular Treatment of Acute Ischemic Stroke Due to Tandem Occlusions: Large Multicenter Series and Systematic Review

Novel and emerging technologies for endovascular thrombectomy

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

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