Background We report our single center experience results of endovascular treatment of anterior circulation of ischemic stroke by the technique of direct aspiration.
Methods Between September 2013 to March 2015 we reviewed the data of 201 patients presenting with large vessels anterior circulation occlusion for which the ADAPT technique was utilized in first intention and was associated with stentriever technique when necessary. Procedural and clinical data were collected for analysis. An univariate analysis of the following factors: Age, prior antiplatelet or anticoagulative therapy, localisation of the occlusion, an intravenous thrombolysis and its type, the time between onset and start of the procedure, the etiology of the stroke (TOAST) was performed to find predictors for success of the ADAPT technique on intent.
Results Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 16 (1–26). Mean onset to femoral puncture time was 285 min. The localisation of arterial occlusion was the MCA in 119/201 (59%), the ICA in 55/201 (27%), a tandem occlusion in 27/201 (13,5%). The treatment were performed under sedation (no general anesthesia) in 155 cases (77%). The aspiration technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 110/201 of cases (55%). The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 83%. With ADAPT alone, the average time from groin puncture to at least TICI 2b recanalization was 45 min (from clot contact to recanalization: 17 min). For the overal series there were 16 cases (8%) of procedural complications (3 non occlusive dissections, 8 emboli in new territory, and 5 Subarachnoid hemorrhages) and 8 symptomatic intracerebral hemorrhages (3,9%) at day 1 imaging. Ninety day functional outcomes (modified Rankin Scale (mRS) was available for 126 patients. Sixty-four patients (51%) had good outcome (mRS 0–2).
Discussion In the anterior circulation, the ADAPT technique alone was effective in 55% of the cases (66% when the localisation was the MCA) and with the use of other techniques (mostly stentrievers) could achieve a recanalization rate of 83%. The ADAPT technique showed to be more efficacious on the MCA location. The thromboembolic events in other territories were low. The relevance of this technique and its use on first intent prior to the use of the stentrievers needs to be studied in larger prospective multicentric studies.
Disclosures R. Blanc: None. H. Redjem: None. B. Bartolini: None. G. Ciccio: None. S. Smajda: None. G. Taylor: None. S. Lamrabet: None. P. Paraschakis: None. M. Piotin: None.
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