Initial results of management for acute ischemic stroke due to large vessel occlusion by a direct aspiration first pass technique at a Vietnamese hospital

Abstract

Background: The development of novel revascularization devices has improved procedural and clinical outcomes in acute ischemic stroke (AIS). A direct aspiration first pass technique (ADAPT) has been introduced as a rapid simple method for achieving good recanalization and clinical outcomes using large bore aspiration catheters in the treatment of AIS due to large vessel occlusion (LVO). Objectives: The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to LVO in the Vietnamese patient population. Materials and Methods: A retrospective analysis of a hospital database was conducted on all patients undergoing stroke therapy with the ADAPT technique at the institution from January 2017 to December 2017. Efficacy and safety were evaluated by the variables: revascularization rates (thrombolysis in cerebral infarction [TICI] score), time to revascularization, procedural complications, and clinical outcomes (modified Rankin scale [mRS] score) at the 90-day follow-up visit. Results: From the database review, 37 AIS patients treated with ADAPT were identified. The mean NIHSS score at presentation was 17.3 and improved to 8.9 at discharged. The average time arterial puncture to revascularization was 32.5 min. TICI 2b/3 revascularization was achieved in 30/37 (81.1%) patients, good clinical outcomes were achieved (mRS 0–2) in 21/37 (56.7%) patients, and mortality rate was 6/37 (16.2%) during follow-up. Conclusions: ADAPT utilizing large bore aspiration catheters appears to be a fast, simple, safe, and effective method for the management of AIS in the Vietnamese patient population.

Initial Results of a Direct Aspiration First-Pass Technique to Treat Acute Ischemic Stroke Patients in Nepal

“…5,10,11 Our successful revascularization rate was also comparable to results from recent studies performed in other LMICs (72-81%), and our rate of good clinical outcome at 90 days was higher than the results from those other studies (50-56%). 12,13 Our median stroke onset to admission time (4.5 hours) was on the high side of those times reported previously (1 to 5 hours). 14,15 Our long stroke onset to admission time is attributable to low public and physician awareness of AIS, the absence of proper infrastructure for patient transport, and delayed interdepartmental communication that results in delays in initial stroke assessment.…”

“… 5 10 11 Our successful revascularization rate was also comparable to results from recent studies performed in other LMICs (72–81%), and our rate of good clinical outcome at 90 days was higher than the results from those other studies (50–56%). 12 13 …”

“…Stroke severity was categorized by the baseline NIHSS as mild (6-10), moderate (11)(12)(13)(14)(15), or severe (> 15). Median and IQR were calculated for numeric variables as appropriate.…”

Comparision of Mechanical Thrombectomy With Contact Aspiration or Stent Retriever in Patients With Large-vessel Occlusion in Acute Ischemic Stroke

“…4 A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke (ADAPT) is also an alternative thrombectomy technique that has become the standard of care at many centers. [5][6][7] This is performed by a large-bore catheter to the face of the thrombus, followed by its removal by aspiration alone or withdrawal of the catheter while aspirating. Previous observation studies focusing on ADAPT reported a higher rate of complete revascularization and potentially a shorter time from groin puncture to reperfusion compared with SRT.…”

“…Stent-retriever thrombectomy (SRT) was established for removing the obstructing thrombus in acute ischemia since 2015 4 . A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke (ADAPT) is also an alternative thrombectomy technique that has become the standard of care at many centers 5–7 . This is performed by a large-bore catheter to the face of the thrombus, followed by its removal by aspiration alone or withdrawal of the catheter while aspirating.…”