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The golden 35 min of stroke intervention with ADAPT: effect of thrombectomy procedural time in acute ischemic stroke on outcome
  1. Ali Alawieh1,
  2. Alyssa K Pierce2,
  3. Jan Vargas2,
  4. Aquilla S Turk2,
  5. Raymond D Turner2,
  6. M Imran Chaudry2,
  7. Alejandro M Spiotta2
  1. 1Medical Scientist Training Program, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Alejandro M Spiotta, Department of Neurosciences, Division of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 210, Charleston, SC 29425, USA; spiotta{at}musc.edu

Abstract

Introduction In acute ischemic stroke (AIS), extending mechanical thrombectomy procedural times beyond 60 min has previously been associated with an increased complication rate and poorer outcomes.

Objective After improvements in thrombectomy methods, to reassess whether this relationship holds true with a more contemporary thrombectomy approach: a direct aspiration first pass technique (ADAPT).

Methods We retrospectively studied a database of patients with AIS who underwent ADAPT thrombectomy for large vessel occlusions. Patients were dichotomized into two groups: ‘early recan’, in which recanalization (recan) was achieved in ≤35 min, and ‘late recan’, in which procedures extended beyond 35 min.

Results 197 patients (47.7% women, mean age 66.3 years) were identified. We determined that after 35 min, a poor outcome was more likely than a good (modified Rankin Scale (mRS) score 0–2) outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score was similar between ‘early recan’ (n=122) (14.7±6.9) and ‘late recan’ patients (n=75) (15.9±7.2). Among ‘early recan’ patients, recanalization was achieved in 17.8±8.8 min compared with 70±39.8 min in ‘late recan’ patients. The likelihood of achieving a good outcome was higher in the ‘early recan’ group (65.2%) than in the ‘late recan’ group (38.2%; p<0.001). Patients in the ‘late recan’ group had a higher likelihood of postprocedural hemorrhage, specifically parenchymal hematoma type 2, than those in the ‘early recan’ group. Logistic regression analysis showed that baseline NIHSS, recanalization time, and atrial fibrillation had a significant impact on 90-day outcomes.

Conclusions Our findings suggest that extending ADAPT thrombectomy procedure times beyond 35 min increases the likelihood of complications such as intracerebral hemorrhage while reducing the likelihood of a good outcome.

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Footnotes

  • Contributors Each author listed above should receive authorship credit based on the material contribution to this article, their revision of this article, and their final approval of this article for submission to this journal.

  • Competing interests Disclosures: AMS: Penumbra consulting, honorarium, speaker bureau; Pulsar Vascular consulting, honorarium, speaker bureau; Microvention consulting, honorarium, speaker bureau, research; Stryker consulting, honorarium, speaker bureau. AST, RDT, and MIC: Codman consulting, honorarium, speaker bureau, research funding; Covidien consulting, honorarium, speaker bureau; Penumbra consulting, honorarium, speaker bureau, research grants; Microvention consulting, honorarium, speaker bureau, research grants; Blockade—stock, consulting, honorarium, speaker bureau; Pulsar vascular stock, consulting, honorarium, speaker bureau, research; Medtronic consulting, honorarium, speaker bureau.

  • Ethics approval Medical University of South Carolina institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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