A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study

Lapergue, Bertrand; Blanc, Raphaël; Guédin, Pierre; Decroix, Jean‐Pierre; Labreuche, Julien; Preda, Cristian; Bartolini, Bruno; Coskun, Oguzhan; Redjem, Hocine; Mazighi, Mikaël; Bourdain, Frédéric; Rodesch, Georges; Piotin, Michel

doi:10.3174/ajnr.a4840

Cited by 127 publications

(103 citation statements)

References 26 publications

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“…26,27 Although no comparative studies have been conducted with ADAPT versus the validated SR technique, some evidences suggest noninferiority 9 or superiority of the ADAPT technique to achieve better reperfusion rates. 7 In this perspective, more insights are needed to identify which patients may benefit from this technique.…”

Section: Discussionmentioning

confidence: 99%

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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

Stroke

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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.

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Section: Discussionmentioning

confidence: 99%

“…[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

Stroke

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“…1) Additionally, high recanalization rates have been reported by the a direct aspiration first pass technique (ADAPT), 7,8) which is a modification of the conventional procedure using the Penumbra system. However, acute occlusion of major intracranial arteries may be caused by embolic lesions that cannot be recanalized by the above devices as well as atherosclerotic lesions and arterial dissection.…”

Section: Discussionmentioning

confidence: 99%

Thrombectomy Using Penumbra System for In-stent Reocclusion after Revascularization with Stent for Acute Stroke: A Case Report

Ota

Matsubara

Izumi

et al. 2017

JNET

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Objective:The authors report a case treated using the Penumbra system for in-stent reocclusion after revascularization with stent for acute intracranial artery occlusion. Case Presentations:The patient was a 37-year-old woman. Endovascular treatment was performed for acute occlusion of the M1 segment of the left middle cerebral artery, and recanalization was achieved eventually by placing an Enterprise Vascular Reconstruction Device (VRD). In-stent reocclusion was noted 9 hours after the procedure, and revascularization was achieved by aspirating the thrombus at the site of occlusion using the Penumbra system. Treatment using the Penumbra system was possible without interference by the stent. Conclusion:Thrombectomy using the Penumbra system is an option for in-stent reocclusion after stent placement for acute intracranial large vessel occlusion.

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“…It may be concerned that the deflection of used device influenced safety because a retrospective study reported a lower rate of symptomatic hemorrhage for contact aspiration compared with stent retrievers. 13) A stent retriever is a device which must be placed within a microcatheter across the occluded segment once before expanded. Furthermore, vessels are stretched to some degree while withdrawing the device.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Heavily T2-weighted MRI to Diagnose Vessel Course Distal to Occluded Artery in Mechanical Thrombectomy for Acute Ischemic Stroke

Minami

Yoshida

Hanayama

et al. 2018

JNET

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Objective: In endovascular thrombectomy for acute ischemic stroke due to large-vessel occlusion, occluded vessels are invisible on MRA or DSA. Heavily T2-weighted MRI sequence, which offers good contrast between cerebrospinal fluid and other brain structures, may contribute to resolve this issue. This study aimed to evaluate the efficacy of this sequence in estimating vessel courses including unexpected aneurysms of the portion more distal to the occlusion site in endovascular thrombectomy. Methods:In all, 23 consecutive patients diagnosed with acute ischemic stroke due to large-vessel occlusion underwent endovascular thrombectomy subsequent to evaluation of several thin-slice coronal sections of heavily T2-weighted MRI in addition to the usual diagnostic MRI. To clarify the usefulness of the heavily T2-weighted MRI, the matching degree of vessel courses diagnosed using this sequence before and after recanalization, intra-or postoperative subarachnoid hemorrhage, reperfusion rate of thrombolysis in cerebral infarction (TICI) 2b-3, and the rate of functional independence (modified Rankin Scale [mRS] score ≤ 2) at 90 days were assessed. And also the following time intervals were calculated: start of imaging to arterial puncture, arterial puncture to first deployment of device, and arterial puncture to reperfusion. Results:The site of occlusion at diagnosis was the internal cerebral artery (ICA) in eight patients, the middle cerebral artery (MCA) in 13, and the anterior cerebral artery and basilar artery in 1 each. The matching of vessel courses before and after treatment was observed in 20 patients (91.3%) except for two patients that useful images could not be provided because of intense body movement and a technical failure. Procedure-related subarachnoid hemorrhage was not recognized in any patient. Successful recanalization of TICI 2b-3 was achieved in 82.6%. The median time from start of imaging to arterial puncture was 51 minutes (interquartile range [IQR]: 38.75-72), arterial puncture to first deployment of device was 41 minutes (32-57), placement of a guiding catheter or completion of carotid stenting to first deployment of device was 20 minutes (13.75-28.5), and arterial puncture to reperfusion was 59 minutes (43.5-99.5), respectively.Functional independence (mRS ≤2) at 90 days was achieved in 43.5% of patients. Heavily T2-weighted MRI was extremely useful in facilitating secure navigation of a microguidewire and microcatheter into invisible vessels during thrombectomy by confirming the courses of occluded vessels in advance. On the other hand, this sequence neither delayed the time to arterial puncture remarkably nor reduced the time required for procedure by estimating of occluded vessels. Conclusion:The heavily T2-weighted MRI sequence can contribute to improve the safety of maneuvers by clarifying the course of occluded vessels in endovascular thrombectomy for large-vessel occlusion.Keywords▶ heavily T2-weighted magnetic resonance imaging, cerebral aneurysm, mechanical thrombectomy, large-vessel occlu...

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A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study

Cited by 127 publications

References 26 publications

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

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

Thrombectomy Using Penumbra System for In-stent Reocclusion after Revascularization with Stent for Acute Stroke: A Case Report

Efficacy of Heavily T2-weighted MRI to Diagnose Vessel Course Distal to Occluded Artery in Mechanical Thrombectomy for Acute Ischemic Stroke

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