Mechanical Thrombectomy by a Direct Aspiration First Pass Technique (ADAPT) in Ischemic Stroke: Results of Monocentric Study Based on Multimodal CT Patient Selection

Abstract

Introduction Mechanical thrombectomy with ADAP-technique of ischemic stroke has been reported as fast and effective. Aim of this study is to evaluate imaging criteria as possible predictors of stroke severity, therapeutic success, and outcome. Materials and Methods Patients (30) presenting from October 2015 to April 2017 with Emergent Large Vessel Occlusion of the anterior circulation were treated with ADAP-technique. 22 received also IV tPA; 8 underwent endovascular treatment only. Every patient was evaluated with noncontrast CT, multiphase angiography-CT, and perfusion CT. Clinical and radiological characteristics were measured. Good clinical outcome was an improvement of 8 points on NIHSS at discharge or a modified Rankin Scale ≤2 at discharge and at 90 days. Results Successful revascularization was obtained in 57% of patients, no procedural complications were witnessed, and only two hemorrhages were reported. Good outcome at discharge was obtained in 11 patients (37%) and predicted by NCCT ASPECT and TICI; outcome at 90 days was predicted by NCCT ASPECT, clot length, and premorbid mRS. Mortality was 23% at discharge and 30% at 90 days. Conclusion ADAPT is an effective endovascular method of stroke treatment with fast procedural times. Multimodal CT evaluation is effective in assessing stroke severity, providing important prognostic information, which is able to select patients for the appropriate treatment.

Risk and Benefit Evaluation: Application of Multiphase Computed Tomography Angiography in Mechanical Thrombectomy for Patients With Acute Ischemic Stroke

“…Among the many outcome-related factors, time is emphasized as the patient's life channel. Some studies showed that the likelihood of favorable long-term outcomes decreased by 10% for each 30-minute extension of reperfusion 14,15 . The mean time from symptom onset to groin puncture in the unfavorable outcome group was significantly longer ( P < 0.05) in our study.…”

Revascularization Outcome Prediction for A Direct Aspiration-First Pass Technique (ADAPT) from Pre-Treatment Imaging and Machine Learning

“…In our data, FPE was significantly associated with smaller clot length (p = 0.007). Guzzardi et al also found that shorter clots were associated with better clinical outcomes in ADAPT [1]. This may be because longer surface area clots have larger friction and adhesion forces against the vessel, making them harder to retrieve and yielding worse thrombectomy outcomes [17].…”

“…We retrospectively collected the patient images, both intra-procedural 2D digital subtraction angiogram (DSA) and CT imaging (nCCT and CTA), and patient medical data from consecutive cases. Cases were excluded if (1) ADAPT was not used as first pass technique, (2) the occlusion was not originating from the M1 segment of the MCA, (3) intra-procedural 2D DSA was not available, (4) CT imaging was not available, (5) the available CT imaging had significant artifacts, poor contrast opacification (i.e., no opacification detected by expert neuroradiologist) or poor definition of the clot (i.e., no hyperdensity sign on nCCT or missing collaterals, resulting in ambiguous definition of clot, especially clot length) and ( 6) patient or treatment information was missing.…”

“…A direct aspiration-first pass technique (ADAPT) using large-bore catheters has emerged as a thrombectomy strategy that can rapidly reperfuse the afflicted vessels after acute ischemic stroke (AIS). Several studies and clinical trials have demonstrated that the ADAPT alone was successful in achieving a final revascularization modified thrombolysis in cerebral infarction (mTICI) 2b to 3 at a rate of 78%, with one or more attempts required to achieve successful reperfusion [1][2][3]. However, data show that the first pass effect (FPE, a modified treatment in cerebral ischemia-mTICI score of 2c and 3 after first pass) only occurs in 27% of ADAPT cases [2].…”

Aspiration Thrombectomy Versus Stent Retriever Thrombectomy Alone for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

“…Moreover, a longer duration of thrombectomy is an independent risk factor for sICH [23]. Multiple studies evaluating procedure duration report faster thrombectomy using aspiration than was observed with stent retrievers [9,16,24]. In contrast to most studies, the observational study by Nishi et al concluded that aspiration thrombectomy resulted in longer procedural times [17].…”