Comparison of Mechanical Thrombectomy with Contact Aspiration, Stent Retriever, and Combined Procedures in Patients with Large-Vessel Occlusion in Acute Ischemic Stroke

Procházka, Václav; Jonszta, Tomáš; Czerný, Daniel; Krajča, Jan; Roubec, Martin; Hurtikova, Eva; Urbanec, René; Streitová, Dana; Pavliska, Lubomír; Vrtková, Adéla

doi:10.12659/msm.913458

Cited by 20 publications

(22 citation statements)

References 54 publications

(49 reference statements)

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“…In previous reports ( 14 , 18 ), ADAPT has been demonstrated to recanalize occlusions more quickly than the SR method. Because longer time in occlusion has been shown to put more quantities of tissue at the risk of becoming infarct core ( 19 ), we applied the ADAPT technique as first-line therapy in most cases.…”

Section: Discussionmentioning

confidence: 89%

Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them?

Cheng

Chen

et al. 2021

Front. Neurol.

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Introduction: Recent trials have demonstrated the superior efficacy of mechanical thrombectomy over other medical treatments for acute ischemic stroke; however, not every large vessel occlusion (LVO) can be recanalized using a single thrombectomy device. Rescue devices were proved to increase the reperfusion rate, but the efficacy is unclear.Objective: In this retrospective study, we evaluated the efficacy of rescue therapy in different locations of LVO.Methods: We analyzed the outcomes of mechanical thrombectomy from a prospective registry of consecutive 82 patients in Taipei Medical University Hospital. The reperfusion rate and the functional outcome were compared in patients who received first-line therapy only and patients who need rescue therapy.Results: An 84.1% reperfusion rate was achieved in our cohort. We applied first-line stent retriever (SR) treatment in 6 patients, among which 4 (66.6%) achieved successful reperfusion. We applied a direct-aspiration first-pass technique (ADAPT) as the first-line treatment in 76 patients, among which 46 (60.5%) achieved successful reperfusion. Successful reperfusion could not be achieved in 30 cases (39.5%); therefore, we applied a second-line rescue SR for 28 patients, and reperfusion was established in 18 (64.3%) of them. These results revealed that the LVO in anterior circulation has a higher chance to respond to SR rescue therapy than posterior circulation lesions (68 vs. 33.3%, P < 0.001). Patients who received only first-line therapy exhibited significantly better functional outcomes than those who were also treated with rescue SR therapy (41.2 vs. 16.7%, P = 0.001). In addition, patients with LVO in the anterior circulation were found to have a higher probability of achieving functional independence than patients with posterior circulation lesions (10.7 vs. 0.0%, P < 0.001). The adjusted multivariate analysis revealed that successful reperfusion and treatment type (first-line or rescue therapy) were significantly related to a modified Rankin Scale (mRS) score at 90 days.Conclusion: This study reveals that rescue SR therapy improves the reperfusion rate. Patients who require rescue SR therapy have a lower likelihood of functional independence. LVO in the anterior circulation responds better to rescue SR therapy and results in better functional outcomes than posterior circulation lesions.

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Section: Discussionmentioning

confidence: 89%

Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them?

Cheng

Chen

et al. 2021

Front. Neurol.

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“…There are two main methods of retrieving a thrombus from an artery: aspiration or using stent retrievers [14]. In our opinion, it is advisable to not introduce metal devices such as stent retrievers into the dissected artery segment in order to prevent vessel walls from incurring further damage.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Stroke Caused by Carotid Artery Dissection

et al. 2020

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Ischemic stroke due to large vessel occlusion (LVO) is a devastating condition. Most LVOs are embolic in nature. Arterial dissection is responsible for only a small proportion of LVOs, is specific in nature and poses some challenges in treatment. We describe 3 cases where patients with stroke caused by carotid artery dissection were treated with mechanical thrombectomy and extensive stenting with good outcome. We believe that mechanical thrombectomy and stenting is a treatment of choice in these cases.

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“…Since fast recanalization is the most important factor in determining the clinical outcomes, multiple endovascular management techniques are needed to recanalize intracranial atherosclerosis-related LVO compared with thromboembolism-related LVO. Two currently principal techniques for mechanical thrombectomy are (1) application of a stent retriever like the Solitaire FR stent (Medtronic Neurovascular, Irvine, CA, USA) and (2) direct aspiration of the thrombus with the technique of A Direct Aspiration First-Pass Thrombectomy (ADAPT) using a large-bore aspiration catheter like the ACE 64 or 5 Max ACE catheter (Penumbra, Alameda, CA, USA) (14,15). Moreover, a stent retriever can be used together with direct aspiration at the proximal end of a thrombus at the time of mechanical thrombectomy (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Endovascular Management of Intracranial Atherosclerosis-Related Large Vessel Occlusion With the A Direct Aspiration First-Pass Thrombectomy Compared With Solumbra Technique

Zhou

et al. 2021

Front. Neurol.

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Background: To investigate the effect of the A Direct Aspiration First-Pass Thrombectomy (ADAPT) vs. Solumbra technique in the treatment of acute intracranial atherosclerosis-related large vessel occlusion (LVO).Methods: Patients with acute atherosclerosis-related LVO who had undergone endovascular treatment were retrospectively enrolled into two groups: The Solumbra and ADAPT groups. The clinical data were analyzed.Results: Patients (104) were enrolled with 48 in the Solumbra and 56 in the ADAPT group. The mean time from femoral access to recanalization was significantly (P < 0.05) shorter in the ADAPT than in the Solumbra group. The recanalization time at the first line was significantly shorter in the ADAPT group than in the Solumbra group (17 ± 10.21 vs. 26 ± 15.55 min, P = 0.02). However, the rate of switching to the alternative was significantly higher in the ADAPT group than that in the Solumbra group (46.42 vs. 33.33%, P = 0.01). Eighty-two patients had eventual recanalization, resulting in a final recanalization rate of 78.85%. At 3-month clinical follow-up for all patients, the good prognosis rate reached 51.92% with good prognosis in 24 patients (50%) in the Solumbra and 30 (53.57%) in the ADAPT group. The rate of symptomatic intracranial hemorrhage was 18.75% (n = 9) in the Solumbra and 19.64% (n = 11) in the ADAPT group. The mortality rate was 21.15% (22/104). Among 80 (76.92%) patients who had angiographic follow-up (3–30 months), five (6.25%) patients experienced in-stent stenosis, and two (2.5%) experienced asymptomatic stent occlusion.Conclusion: In patients with acute intracranial atherosclerosis-related LVO, clinical outcomes treated using the ADAPT technique are comparable with those using the Solumbra technique, and more patients need additional remedial measures if treated with the ADAPT technique.

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Comparison of Mechanical Thrombectomy with Contact Aspiration, Stent Retriever, and Combined Procedures in Patients with Large-Vessel Occlusion in Acute Ischemic Stroke

Cited by 20 publications

References 54 publications

Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them?

Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them?

Endovascular Treatment of Stroke Caused by Carotid Artery Dissection

Endovascular Management of Intracranial Atherosclerosis-Related Large Vessel Occlusion With the A Direct Aspiration First-Pass Thrombectomy Compared With Solumbra Technique

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