ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy

Turk, Aquilla S; Frei, Don; Fiorella, David; Mocco, J; Baxter, Blaise; Siddiqui, Adnan H.; Spiotta, A; Mokin, Maxim; Dewan, Michael C.; Quarfordt, Steve; Battenhouse, Holly; Turner, Raymond D; Chaudry, Imran

doi:10.1136/neurintsurg-2014-011125

Cited by 413 publications

(279 citation statements)

References 22 publications

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“…The choice of technique was left to the discretion of the treating neurointerventionist. The details of these thrombectomy techniques were described previously 11, 12, 13. When the selected first‐line thrombectomy technique failed to achieve successful reperfusion, the neurointerventionist switched to the other technique.…”

Section: Methodsmentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Kang

Jung

Yoon

et al. 2018

JAHA

116

117

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BackgroundDespite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion (BAO). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO.Methods and ResultsThis study included 212 consecutive patients with acute BAO who underwent either stent‐retriever or contact aspiration thrombectomy as the first‐line approach between January 2011 and August 2017 at 3 stroke centers. Clinical and radiologic data were prospectively collected and stored in a database at each center. Multivariable ordinal logistic regression was performed to assess the association between each characteristic and 90‐day modified Rankin scale scores. Reperfusion was successful in 91.5% (194/212) of patients; 44.8% (95/212) of patients achieved 90‐day modified Rankin scale 0 to 2. The symptomatic hemorrhage rate was 1.9% (4/212) and mortality was 16% (34/212). In a multivariable ordinal regression, younger age, lower National Institute of Health stroke scale on admission, and absence of diabetes mellitus and parenchymal hematoma were significantly associated with a favorable shift in the overall distribution of 90‐day modified Rankin scale scores. Treatment outcomes were similar between patients who received stent‐retriever thrombectomy and contact aspiration thrombectomy as the first‐line technique.ConclusionsEndovascular thrombectomy was effective and safe for treating patients with acute BAO. Age, the baseline National Institute of Health stroke scale, diabetes mellitus, and parenchymal hematoma were associated with better outcomes. This study showed no superiority of the stent‐retriever over the aspiration thrombectomy for treating acute BAO.

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Section: Methodsmentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Kang

Jung

Yoon

et al. 2018

JAHA

116

117

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“…One potential explanation is that in ADAPT FAST, only 5% of cases involved the posterior circulation, which might be more challenging for the primary aspiration approach. 7 Son et al 22 compared procedural details of basilar artery occlusion thrombectomy from a single center, where 13 patients were treated with the Solitaire stent retriever and 18 patients were treated with primary aspiration thrombectomy alone. There was no significant difference between clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Primary aspiration was considered the first-line strategy, when aspiration thrombectomy with a large-bore aspiration catheter alone was attempted first, according to the technique described previously. 7,11 Successful recanalization was defined as a Thrombolysis in Cerebral Infarction (TICI) score of 2b/3. 12 Functional neurological outcomes were quantified using the modified Rankin Scale at 90 days.…”

Section: Methodsmentioning

confidence: 99%

“…6 Outside of clinical trials, endovascular therapy of posterior circulation strokes with stent retrievers and modern distal aspiration catheters is currently offered to a variety of patients using different selection criteria and treatment approaches, resulting in a wide range of clinical outcomes. [7][8][9][10] However, clinical and imaging predictors of success outcomes, and optimal recanalization approaches in this specific group of patients are not understood as well as in anterior circulation strokes because posterior circulation strokes have not been studied extensively. The aim of this study was to review our recent multicenter experience with endovascular treatment of …”

mentioning

confidence: 99%

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Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes

Mokin

Sonig

Sivakanthan

et al. 2016

Stroke

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132

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5) demonstrated superiority of modern endovascular thrombectomy approaches in patients with acute ischemic stroke from large vessel occlusion when compared Background and Purpose-Patients with posterior circulation strokes have been excluded from recent randomized endovascular stroke trials. We reviewed the recent multicenter experience with endovascular treatment of posterior circulation strokes to identify the clinical, radiographic, and procedural predictors of successful recanalization and good neurological outcomes. Methods-We performed a multicenter retrospective analysis of consecutive patients with posterior circulation strokes, who underwent thrombectomy with stent retrievers or primary aspiration thrombectomy (including A Direct Aspiration First Pass Technique [ADAPT] approach). We correlated clinical and radiographic outcomes with demographic, clinical, and technical characteristics. Results-A total of 100 patients were included in the final analysis (mean age, 63.5±14.2 years; mean admission National Institutes of Health Stroke Scale score, 19.2±8.2). Favorable clinical outcome at 3 months (modified Rankin Scale score ≤2) was achieved in 35% of patients. Successful recanalization and shorter time from stroke onset to the start of the procedure were significant predictors of favorable clinical outcome at 90 days. Stent retriever and aspiration thrombectomy as primary treatment approaches showed comparable procedural and clinical outcomes. None of the baseline advanced imaging modalities (magnetic resonance imaging, computed tomographic perfusion, or computed tomography angiography assessment of collaterals) showed superiority in selecting patients for thrombectomy. Conclusions-Time

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“…7 Single-arm studies have shown aspiration-based thrombectomy to safely facilitate rapid reperfusion in large vessel occlusion stroke patients. [11][12][13][14][15] Local aspiration may play an important role when used with stent retrievers for thrombectomy. 16 A fundamental question surrounding the recent overwhelming evidence supporting thrombectomy is whether this benefit is exclusive to stent retrievers as the primary approach or may result from other approaches.…”

Section: Strokementioning

confidence: 99%

Aspiration Thrombectomy After Intravenous Alteplase Versus Intravenous Alteplase Alone

Mocco

Zaidat

Kummer

et al. 2016

Stroke

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262

191

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Background and Purpose-Thrombectomy, primarily with stent retrievers with or without adjunctive aspiration, provided clinical benefit across multiple prospective randomized trials. Whether this benefit is exclusive to stent retrievers is unclear. Methods-THERAPY (The Randomized, Concurrent Controlled Trial to Assess the Penumbra System's Safety and Effectiveness in the Treatment of Acute Stroke; NCT01429350) was an international, multicenter, prospective, randomized (1:1), open label, blinded end point evaluation, concurrent controlled clinical trial of aspiration thrombectomy after intravenous alteplase (IAT) administration compared with intravenous-alteplase alone in patients with large vessel ischemic stroke because of a thrombus length of ≥8 mm. The primary efficacy end point was the percent of patients achieving independence at 90 days (modified Rankin Scale score, 0-2; intention-to-treat analysis). The primary safety end point was the rate of severe adverse events (SAEs) by 90 days (as treated analysis). Patients were randomized 1:1 across 36 centers in 2 countries (United States and Germany). Results-Enrollment was halted after 108 (55 IAT and 53 intravenous) patients (of 692 planned) because of external evidence of the added benefit of endovascular therapy to intravenous-alteplase alone. Functional independence was achieved in 38% IAT and 30% intravenous intention-to-treat groups (P=0.52). Intention-to-treat ordinal modified Rankin Scale odds ratio was 1.76 (95% confidence interval, 0.86-3.59; P=0.12) in favor of IAT. Secondary efficacy analyses all demonstrated a consistent direction of effect toward benefit of IAT. No differences in symptomatic intracranial hemorrhage rates (9.3% IAT versus 9.7% intravenous, P=1.0) or 90-day mortality (IAT: 12% versus intravenous: 23.9%, P=0.18) were observed. Conclusions-THERAPY did not achieve its primary end point in this underpowered sample. Directions of effect for all prespecified outcomes were both internally and externally consistent toward benefit. It is possible that an alternate method of thrombectomy, primary aspiration, will benefit selected patients harboring large vessel occlusions. Further study on this topic is indicated. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01429350.

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ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy

Cited by 413 publications

References 22 publications

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes

Aspiration Thrombectomy After Intravenous Alteplase Versus Intravenous Alteplase Alone

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