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

Abstract

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.

Comparing different thrombectomy techniques in five large-volume centers: a ‘real world’ observational study

“…Likely explanations for this discrepancy could be the ‘real world’ design of our series as well as the frequencies’ discrepancy of ICA occlusions treated in our study (with ~30%) as opposed to the frequency in the ASTER trial (with ~10%). Clot length and overall mass is bigger in ICA occlusions leading to more device passes and lower reperfusion rates 24. The results of our stent-retriever group correlate well with the angiographic results published in the MR-CLEAN and THRACE trials 15 25.…”

Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot

“…Blanc et al 24 identified clot location as the main factor related to DTA efficacy with a high rate of successful recanalization for M1 occlusions and a low rate for carotid artery terminus occlusions. The authors suggested that there was a more effective interaction in the M1 location between the aspiration catheter and the clot due to the better correspondence between the vessel and the catheter diameters.…”

Anterior cerebral artery embolism during thrombectomy increases disability and mortality

“…The ADAPT approach may present with a lower risk of embolic complications due to the aspiration component allowing an en bloc clot extraction in up to 78%12 without passage through the thrombus, theoretically reducing the risk of fragmentation. Nevertheless, our results support the fact that SR alone without aspiration is an independent factor for ACAE, with a 2.6-fold increased risk.…”