Impact of reperfusion pump power on technical and clinical outcomes after direct aspiration thrombectomy (ADAPT)

Abstract

IntroductionHigher aspiration forces using larger bore catheters in direct aspiration thrombectomy (ADAPT) have been associated with shorter procedure time and better outcomes in patients treated for acute ischemic stroke (AIS). However, the effect of using reperfusion pumps of higher aspiration power on outcomes of ADAPT has not been investigated. We evaluated the effect of using pumps with different aspiration powers on technical and clinical outcomes after ADAPT.MethodsWe reviewed a retrospective database of AIS cases between January 2018 and February 2019, while comparing technical and clinical outcomes between patients undergoing ADAPT using the MAX pump (28.5 inHg power) vs the ENGINE pump(29.2 inHg power).ResultsAmong 194 patients (48% females, age 69±15 years) included in the study, 73 patients undergoing ADAPT using the ENGINE pump were age-, gender-, comorbidities-, and operator-matched to 118 patients treated using the MAX pump. The ENGINE group had shorter procedure time (20±17 vs 27±21 mins, p=0.017), lower number of aspiration attempts (2.2±1.6 vs 2.8±1.9, p=0.047), and similar rates of favorable 90 day modified Rankin Scale. Using multivariate linear regression, the use of the ENGINE reperfusion pump with higher vacuum power was independently and inversely correlated with procedure time (coefficient −2.23, p=0.027). While controlling for confounders, there was a trend toward an inverse correlation between use of the ENGINE pump and the number of attempts on linear regression (coefficient −1.04, p=0.09) and lower odds of PH2/intracranial (ICH) hemorrhages on logistic regression (OR 0.227, p=0.075).ConclusionOur findings suggest that the use of the ENGINE reperfusion pump of higher aspiration power during ADAPT decreases procedure time, without increasing complications and post-procedural hemorrhage rates.

European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage

“… 120 , 121 In addition, different observational studies have evaluated blood pressure levels following successful recanalisation in AIS patients due to large vessel occlusion and have consistently reported an inverse association between increasing post-reperfusion blood pressures and good functional outcomes at three months. 122 – 124 They also highlight, that systolic blood pressure levels < 140 mm Hg post MT are related to the higher odds of good functional outcome. Also, a single-centre study has recently documented that spontaneous systolic blood pressure drop after MT is an early predictor of dramatic neurological recovery (defined as 8-point-reduction in baseline NIHSS-score or an overall NIHSS ≤ 2 points at 24 h) in large vessel occlusion patients that receive endovascular treatment.…”