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ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy
  1. Aquilla S Turk1,
  2. Don Frei2,
  3. David Fiorella3,
  4. J Mocco4,
  5. Blaise Baxter5,
  6. Adnan Siddiqui6,
  7. Alex Spiotta7,
  8. Maxim Mokin3,
  9. Michael Dewan8,
  10. Steve Quarfordt5,
  11. Holly Battenhouse9,
  12. Raymond Turner7,
  13. Imran Chaudry1
  1. 1Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
  3. 3Department of Neurological Surgery, Stony Brook Medicine, Stony Brook, New York, USA
  4. 4Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA
  5. 5Tennessee Interventional Associates, Chattanooga, Tennessee, USA
  6. 6Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA
  7. 7Division of Neurosciences, Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  8. 8Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee, USA
  9. 9Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr A S Turk, Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 210, Charleston, SC 29425, USA; turk{at}musc.edu

Abstract

Background The development of new revascularization devices has improved recanalization rates and time, but not clinical outcomes. We report a prospectively collected clinical experience with a new technique utilizing a direct aspiration first pass technique with large bore aspiration catheter as the primary method for vessel recanalization.

Methods 98 prospectively identified acute ischemic stroke patients with 100 occluded large cerebral vessels at six institutions were included in the study. The ADAPT technique was utilized in all patients. Procedural and clinical data were captured for analysis.

Results The aspiration component of the ADAPT technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 78% of cases. The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 95%. The average time from groin puncture to at least TICI 2b recanalization was 37 min. A 5MAX demonstrated similar success to a 5MAX ACE in achieving TICI 2b/3 revascularization alone (75% vs 82%, p=0.43). Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 17.0 (12.0–21.0) and improved to a median NIHSS score at discharge of 7.3 (1.0–11.0). Ninety day functional outcomes were 40% (modified Rankin Scale (mRS) 0–2) and 20% (mRS 6). There were two procedural complications and no symptomatic intracerebral hemorrhages.

Discussion The ADAPT technique is a fast, safe, simple, and effective method that has facilitated our approach to acute ischemic stroke thrombectomy by utilizing the latest generation of large bore aspiration catheters to achieve previously unparalleled angiographic outcomes.

  • Thrombectomy
  • Stroke

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