Ali Alawieh1,2, A Rano Chatterjee3, Jan Vargas2, M Imran Chaudry2, Jonathan Lena2, Raymond Turner2, Aquilla Turk2, Alejandro Spiotta2. 1. Medical Scientist Training Program, Medical University of South Carolina, Charleston, South Carolina. 2. Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina. 3. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
Abstract
BACKGROUND: Endovascular thrombectomy is currently the standard of care for acute ischemic stroke (AIS). Although earlier trials on endovascular thrombectomy were performed using stent retrievers, recently completed the contact aspiration vs stent retriever for successful revascularization (ASTER) and a comparison of direct aspiration versus stent retriever as a first approach (COMPASS) trials have shown the noninferiority of direct aspiration. OBJECTIVE: To report the largest experience with ADAPT thrombectomy and compare the impact of advancement in reperfusion catheter technologies on outcomes. METHODS: We reviewed a retrospective database of AIS patients who underwent ADAPT thrombectomy between January 2013 and November 2017 at the Medical University of South Carolina. Demographics and baseline characteristics, technical variables, and radiological and clinical outcomes were reviewed. RESULTS: Among 510 patients (mean age: 67.7, 50.6% females), successful recanalization at first pass was achieved in 61.8%, and with aspiration only in 77.5%. Mean procedure time was 27.4 min, and the rate of good outcomes (mRS 0-2) at 90 d was 42.9%. The rate of recanalization with aspiration only was significantly higher, and procedure time was significantly lower in patients treated with larger catheters (ACE 064 and ACE 068) compared to smaller catheters (5 MAX and ACE, P < .05). There were no differences in complication rates or postoperative parenchymal hemorrhage across groups (P > .05); however, use of ACE 068 was an independent predictor of good outcomes at 90 d on multivariate regression analysis (odds ratio = 1.6, P < .05). CONCLUSION: Refinement of ADAPT thrombectomy by incorporating reperfusion catheters with higher inner diameters and thus higher aspiration forces is associated with better outcomes, shorter procedure times, and lower likelihood of using additional devices without impacting complication rates.
BACKGROUND: Endovascular thrombectomy is currently the standard of care for acute ischemic stroke (AIS). Although earlier trials on endovascular thrombectomy were performed using stent retrievers, recently completed the contact aspiration vs stent retriever for successful revascularization (ASTER) and a comparison of direct aspiration versus stent retriever as a first approach (COMPASS) trials have shown the noninferiority of direct aspiration. OBJECTIVE: To report the largest experience with ADAPT thrombectomy and compare the impact of advancement in reperfusion catheter technologies on outcomes. METHODS: We reviewed a retrospective database of AISpatients who underwent ADAPT thrombectomy between January 2013 and November 2017 at the Medical University of South Carolina. Demographics and baseline characteristics, technical variables, and radiological and clinical outcomes were reviewed. RESULTS: Among 510 patients (mean age: 67.7, 50.6% females), successful recanalization at first pass was achieved in 61.8%, and with aspiration only in 77.5%. Mean procedure time was 27.4 min, and the rate of good outcomes (mRS 0-2) at 90 d was 42.9%. The rate of recanalization with aspiration only was significantly higher, and procedure time was significantly lower in patients treated with larger catheters (ACE 064 and ACE 068) compared to smaller catheters (5 MAX and ACE, P < .05). There were no differences in complication rates or postoperative parenchymal hemorrhage across groups (P > .05); however, use of ACE 068 was an independent predictor of good outcomes at 90 d on multivariate regression analysis (odds ratio = 1.6, P < .05). CONCLUSION: Refinement of ADAPT thrombectomy by incorporating reperfusion catheters with higher inner diameters and thus higher aspiration forces is associated with better outcomes, shorter procedure times, and lower likelihood of using additional devices without impacting complication rates.
Authors: Scott B Raymond; Mehr Nasir-Moin; Matthew J Koch; James D Rabinov; Thabele Leslie-Mazwi; Aman B Patel Journal: Interv Neuroradiol Date: 2020-01-22 Impact factor: 1.610
Authors: Ahmad Sweid; Batoul Hammoud; Kimon Bekelis; Symeon Missios; Stavropoula I Tjoumakaris; Michael R Gooch; Nabeel A Herial; Hekmat Zarzour; Victor Romo; Maureen DePrince; Robert H Rosenwasser; Pascal Jabbour Journal: Int J Stroke Date: 2020-06-26 Impact factor: 5.266
Authors: E Pampana; S Fabiano; G De Rubeis; L Bertaccini; A Stasolla; A Vallone; A Pingi; M Mangiardi; S Anticoli; C Gasperini; E Cotroneo Journal: AJNR Am J Neuroradiol Date: 2021-01-21 Impact factor: 3.825