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

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.

“…[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

“…Finally, excellent recanalization rates have been reported using suction catheters alone. 26 In summary, these trials were successful because reperfusion was achieved quickly and with high reperfusion rates. Interventionists need to closely monitor these metrics in their own practice to ensure that they are achieving similar performance.…”

Section: Devices/proceduresmentioning

confidence: 99%

Interventionalist Perspective on the New Endovascular Trials

Pierot,

Derdeyn

2015

Abstract-Three recently published trials have conclusively proven the benefit of mechanical endovascular thrombectomy over best medical therapy for patients with acute ischemic stroke and large vessel occlusion. These trials shared some features and differed in others. These similarities and differences in trial design and execution affect the conclusions and recommendations that can be made from the data. We will examine the implications of these studies for neurointerventionists, both for current practice and for future studies. In particular, we will focus on procedural details such as patient selection, devices, adjunctive therapies, treatment time windows, and performance metrics. (Stroke.

“…Primary aspiration was considered the first-line strategy, when aspiration thrombectomy with a large-bore aspiration catheter alone was attempted first, according to the technique described previously. 7,11 Successful recanalization was defined as a Thrombolysis in Cerebral Infarction (TICI) score of 2b/3. 12 Functional neurological outcomes were quantified using the modified Rankin Scale at 90 days.…”

Section: Methodsmentioning

confidence: 99%

Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes

Mokin

Sonig

Sivakanthan

et al. 2016

Self Cite

136

5) demonstrated superiority of modern endovascular thrombectomy approaches in patients with acute ischemic stroke from large vessel occlusion when compared Background and Purpose-Patients with posterior circulation strokes have been excluded from recent randomized endovascular stroke trials. We reviewed the recent multicenter experience with endovascular treatment of posterior circulation strokes to identify the clinical, radiographic, and procedural predictors of successful recanalization and good neurological outcomes. Methods-We performed a multicenter retrospective analysis of consecutive patients with posterior circulation strokes, who underwent thrombectomy with stent retrievers or primary aspiration thrombectomy (including A Direct Aspiration First Pass Technique [ADAPT] approach). We correlated clinical and radiographic outcomes with demographic, clinical, and technical characteristics. Results-A total of 100 patients were included in the final analysis (mean age, 63.5±14.2 years; mean admission National Institutes of Health Stroke Scale score, 19.2±8.2). Favorable clinical outcome at 3 months (modified Rankin Scale score ≤2) was achieved in 35% of patients. Successful recanalization and shorter time from stroke onset to the start of the procedure were significant predictors of favorable clinical outcome at 90 days. Stent retriever and aspiration thrombectomy as primary treatment approaches showed comparable procedural and clinical outcomes. None of the baseline advanced imaging modalities (magnetic resonance imaging, computed tomographic perfusion, or computed tomography angiography assessment of collaterals) showed superiority in selecting patients for thrombectomy. Conclusions-Time