Daniele Giuseppe Romano1, Giulia Frauenfelder2, Tommaso Casseri3, Mariangela Piano4, Sergio Vinci5, Alessio Comai6, Alessandro Stecco7, Francesco Causin8, Francesco Asteggiano9, Aldo Paolucci10, Chiara Comelli11, Andrea Giorgianni12, Luigi Cirillo13, Giuseppe Ganci14, Samuele Cioni3, Antonio Pitrone5, Guglielmo Pero4, Rosario Papa5, Mario Muto15, Renato Saponiero1, Sandra Bracco3. 1. UOC di Neuroradiologia Diagnostica ed Interventistica, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy. 2. Unità di Radiologia Diagnostica ed Interventistica, Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy. g.frauenfelder@unicampus.it. 3. Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Siena, Italy. 4. Unità di Neuroradiologia, Dipartimento Tecnologie Avanzate, ASST, Grande Ospedale Metropolitano Niguarda, Milan, Italy. 5. Neuroradiology Unit, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy. 6. Servizio Interaziendale Neuroradiologia di Bolzano, Bolzano, Italy. 7. Neuroradiology Unit, AOU Maggiore della Carita', Universita' del Piemonte Orientale, Novara, Italy. 8. Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy. 9. Neuroradiology Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy. 10. Neuroradiology, Fondazione IRCCS Ca' Granda Policlinico Ospedale Maggiore, Milan, Italy. 11. S.C. Radiodiagnostica, Ospedale San Giovanni Bosco (ASL Città di Torino), Turin, Italy. 12. UOC Neuroradiologia, Ospedale di Circolo di Varese, Varese, Italy. 13. UOC Neuroradiologia, Ospedale Bellaria, Bologna, Italy. 14. UOC Neuroradiologia, Ospedale Santa Corona, Pietra Ligure, Italy. 15. UOC di Neuroradiologia Diagnostica ed Interventistica, AORN A. Cardarelli, Naples, Italy.
Abstract
INTRODUCTION: A direct aspiration first pass technique (ADAPT) is an alternative technique as first-line thrombectomy for large vessel occlusion in acute ischemic stroke, still debated when compared to first-line stent retriever. To retrospectively evaluate technical and clinical outcomes of the ADAPT as first-line treatment for anterior circulation acute ischemic stroke with large-bore reperfusion catheters. METHODS: A multicentric data collection from 14 medical centers was retrospectively analyzed. Large-bore catheters had a distal diameter between 0.64 and 0.71 in; stent retriever was added when aspiration alone failed. Baseline characteristics, technical and clinical variables were collected, including NIHSS, thrombolysis in cerebral infarction (TICI), peri-procedural complications, 90-day mRS and 90-day mortality. RESULTS: Overall, 501 patients were treated. No statistically significant difference in terms of baseline features or tPA administration was recorded between patients treated with ADAPT and with additional stent retriever. ADAPT alone was successful in achieving TICI ≥ 2b in 71.8% with a median of 1.55 aspiration attempts. In terms of TICI ≥ 2b, ADAPT alone was better than additional stent retriever (p < 0.001), while no statistical difference was achieved from catheter diameter. Embolization to a new territory was less frequent in ADAPT group (5.2 vs 18%; p = 0.0026). Patients treated with ADAPT alone had better clinical outcomes in terms of mRS ≤ 2 (p < 0.001). CONCLUSIONS: ADAPT is a valid technique with respect to the rates of TICI 2b/3 recanalization and 90-day mRS scores. In this series, an attempt at recanalization with ADAPT with larger-bore reperfusion catheter may be warranted prior to stentriever thrombectomy.
INTRODUCTION: A direct aspiration first pass technique (ADAPT) is an alternative technique as first-line thrombectomy for large vessel occlusion in acute ischemic stroke, still debated when compared to first-line stent retriever. To retrospectively evaluate technical and clinical outcomes of the ADAPT as first-line treatment for anterior circulation acute ischemic stroke with large-bore reperfusion catheters. METHODS: A multicentric data collection from 14 medical centers was retrospectively analyzed. Large-bore catheters had a distal diameter between 0.64 and 0.71 in; stent retriever was added when aspiration alone failed. Baseline characteristics, technical and clinical variables were collected, including NIHSS, thrombolysis in cerebral infarction (TICI), peri-procedural complications, 90-day mRS and 90-day mortality. RESULTS: Overall, 501 patients were treated. No statistically significant difference in terms of baseline features or tPA administration was recorded between patients treated with ADAPT and with additional stent retriever. ADAPT alone was successful in achieving TICI ≥ 2b in 71.8% with a median of 1.55 aspiration attempts. In terms of TICI ≥ 2b, ADAPT alone was better than additional stent retriever (p < 0.001), while no statistical difference was achieved from catheter diameter. Embolization to a new territory was less frequent in ADAPT group (5.2 vs 18%; p = 0.0026). Patients treated with ADAPT alone had better clinical outcomes in terms of mRS ≤ 2 (p < 0.001). CONCLUSIONS: ADAPT is a valid technique with respect to the rates of TICI 2b/3 recanalization and 90-day mRS scores. In this series, an attempt at recanalization with ADAPT with larger-bore reperfusion catheter may be warranted prior to stentriever thrombectomy.
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Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
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Authors: Mayank Goyal; Andrew M Demchuk; Bijoy K Menon; Muneer Eesa; Jeremy L Rempel; John Thornton; Daniel Roy; Tudor G Jovin; Robert A Willinsky; Biggya L Sapkota; Dar Dowlatshahi; Donald F Frei; Noreen R Kamal; Walter J Montanera; Alexandre Y Poppe; Karla J Ryckborst; Frank L Silver; Ashfaq Shuaib; Donatella Tampieri; David Williams; Oh Young Bang; Blaise W Baxter; Paul A Burns; Hana Choe; Ji-Hoe Heo; Christine A Holmstedt; Brian Jankowitz; Michael Kelly; Guillermo Linares; Jennifer L Mandzia; Jai Shankar; Sung-Il Sohn; Richard H Swartz; Philip A Barber; Shelagh B Coutts; Eric E Smith; William F Morrish; Alain Weill; Suresh Subramaniam; Alim P Mitha; John H Wong; Mark W Lowerison; Tolulope T Sajobi; Michael D Hill Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245