Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center

Kowoll, Annika; Weber, Anushe; Mpotsaris, Anastasios; Behme, Daniel; Weber, W.

doi:10.1136/neurintsurg-2014-011520

Cited by 91 publications

(91 citation statements)

References 23 publications

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“…18 ADAPT was implemented as described in detail previously. 4,6 Briefly, a large-bore guide catheter such as a Neuron Max 0.088 inches (Penumbra Inc, Alameda, CA) was placed distally into the internal carotid artery followed by the aspiration catheter (Penumbra ACE or ACE64) which was advanced at the thrombus surface, usually over a microcatheter and micro guidewire. Aspiration was applied, and either the clot was ingested within the catheter or was affixed at the catheter tip and withdrawn under continuous vacuum exerted by a dedicated aspiration pump.…”

Section: Endovascular Proceduresmentioning

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: Endovascular Proceduresmentioning

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][2][3][4][5] Retrospective studies have reported a high rate of revascularization (TICI 2b/3 Ͼ 90%) with the ADAPT approach, with low complication rates such as 2% embolization in a new territory and no incidence of symptomatic intracranial hemorrhage. 24,25 The imbalance of prior rtPA use, which was higher in the ADAPT group (66.1% versus 45.4% in the Solitaire group), may have impacted the rate of successful recanalization. However, the adjusted analysis for all confounding factors, including rtPA use, confirms the higher rate of recanalization in the ADAPT group.…”

Section: Discussionmentioning

confidence: 99%

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

Lapergue

Blanc

Guédin

et al. 2016

AJNR Am J Neuroradiol

128

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BACKGROUND AND PURPOSE:Mechanical thrombectomy with stent retrievers is now the standard therapy for selected patients with ischemic stroke. The technique of A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke (ADAPT) appears promising with a high rate of recanalization. We compared ADAPT versus stent retrievers (the Solitaire device) for efficacy and safety as a front-line endovascular procedure.

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“…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%

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

Mokin

Sonig

Sivakanthan

et al. 2016

Stroke

134

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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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Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center

Cited by 91 publications

References 23 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

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

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

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