Manual thromboaspiration technique as a first approach for endovascular stroke treatment: A single-center experience

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> For intracranial large vessel occlusion in acute ischemic stroke (AIS), a high degree of revascularization in the minimal amount of time predicts good outcomes. Recently, different studies have shown that the direct aspiration first pass technique (ADAPT technique) for AIS obtains high recanalization rates, fast interventions and low costs when it works as first attempt. This study retrospectively describes revascularization efficacy, duration of procedure, intra and post-procedural complications, early and after 90-days clinical outcome in a group of patients who underwent ADAPT as the primary endovascular approach, eventually followed by stent retriever thrombectomy, for recanalization of large vessels in the anterior circulation. </jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p> We analyzed clinical and procedural data of patients treated from April 2014 to August 2015. Recanalization was assessed according to the Thrombolysis in Cerebral Infarction score. Clinical outcome was evaluated at discharge and after 3 months (modified Rankin Scale, mRS). </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Overall, 71 patients (mean age of 69.7 years) were treated. Sites of occlusion were anterior circulation (including seven tandem extracranial-intracranial occlusions). In 39 patients i.v. rtPA was attempted. Recanalization of the target vessel was obtained in 87.3% of cases whereas direct aspiration alone was successful in 46/71cases (64.8%) with an average puncture-to-revascularization time of 43.1 minutes. Symptomatic intracranial hemorrhage occurred in 7.8% and embolization to new territories in 5.6%. In total, 38 patients (53.5%) had a good outcome at 90 days follow-up. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> In our series, the manual thromboaspiration technique has been shown as fast and safe, with good rates of vessel revascularization in 87.3% of patients and neurological outcome &lt;3 mRS in 53.5% of patients. </jats:p></jats:sec>

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

“…[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.…”

Iodine Extravasation Quantification on Dual-Energy CT of the Brain Performed after Mechanical Thrombectomy for Acute Ischemic Stroke Can Predict Hemorrhagic Complications

“…Endovascular procedures were performed on a biplane x-ray system (Allura Xper FD20/20; Philips Healthcare, Best, the Netherlands) by 1 of a pool of 4 radiologists with 3-25 years of experience in interventional neuroradiology. All patients were treated according to a sequential approach that consisted of first-line aspiration using a 5MAX/4MAX reperfusion catheter (Penumbra, Alameda, California) followed by mechanical thrombectomy with a Solitaire Flow-Restoration stent retriever (Covidien, Irvine, California) [22][23][24][25] if aspiration was unsuccessful.…”

Combined use of contact aspiration and the stent retriever technique versus stent retriever alone for recanalization in acute cerebral infarction: the randomized ASTER 2 study protocol

“…Both European and American recommendations propose that clinical trials be conducted to determine the thrombectomy device that achieves the highest rate of successful recanalization 1–4. Contact aspiration (CA) is a novel thrombectomy technique involving aspiration of the thrombus through a large-bore catheter 5–18. The CA technique employs large-bore aspiration catheters that have the advantage of being easily tracked for introduction into the cerebral circulation and removal of the thrombus via negative pressure aspiration.…”