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Ischemic Stroke
Original research
Larger ACE 68 aspiration catheter increases first-pass efficacy of ADAPT technique
  1. Josser E Delgado Almandoz1,
  2. Yasha Kayan1,
  3. Adam N Wallace1,
  4. Ronald M Tarrel2,
  5. Jennifer L Fease1,
  6. Jill Marie Scholz1,
  7. Anna M Milner1,
  8. Pezhman Roohani2,
  9. Maximilian Mulder3,
  10. Mark L Young2
  1. 1 Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
  2. 2 Division of Vascular Neurology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
  3. 3 Division of Critical Care Medicine, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Josser E Delgado Almandoz, Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA; josser.delgado{at}crlmed.com

Abstract

Purpose To report the efficacy of A Direct Aspiration first-Pass Thrombectomy (ADAPT) technique with larger-bore ACE aspiration catheters as first-line treatment for anterior circulation emergent large vessel occlusions (ELVOs), and assess for the presence of a first-pass effect with ADAPT.

Methods We retrospectively reviewed 152 consecutive patients with anterior circulation ELVOs treated with the ADAPT technique as first-line treatment using ACE60, 64, or 68 at our institution. Baseline characteristics, procedural variables, and modified Rankin Scale (mRS) at 90 days were recorded.

Results Fifty-seven patients were treated with ACE60 (37.5%), 35 with ACE64 (23%), and 60 with ACE68 (39.5%). Median groin puncture to reperfusion time was 30 min with ACE60, 26 min with ACE64, and 19.5 min with ACE68. Successful reperfusion after the first ADAPT pass was 33% with ACE60 and 53% with ACE68 (P=0.04). The stent-retriever rescue rate was 26% with ACE60, 3% with ACE64, and 10% with ACE68 (P=0.004). In multivariate logistic regression analysis, use of the ACE68 aspiration catheter was an independent predictor of successful reperfusion after the first ADAPT pass (P=0.016, OR1.67, 95% CI 1.1 to 2.54), and successful reperfusion after the first ADAPT pass was an independent predictor of good clinical outcome at 90 days (P=0.0004, OR6.2, 95% CI 2.27 to 16.8).

Conclusion Use of the larger-bore ACE 68 aspiration catheter was associated with shorter groin puncture to reperfusion time, higher rate of successful reperfusion after the first ADAPT pass, and lower rate of stent-retriever rescue. Further, a first-pass effect was demonstrated in our ADAPT patient cohort.

  • intervention
  • stroke
  • thrombectomy
  • catheter

https://doi.org/10.1136/neurintsurg-2018-013957

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    Footnotes

    • Contributors JEDA: Design of the work; acquisition, analysis, and interpretation of the data for the work; drafting of the work; final approval of the version to be published; and accountable for all aspects of the work. YK, ANW, MLY: Design of the work; acquisition, analysis, and interpretation of the data for the work; critical revision of the work for important intellectual content; final approval of the version to be published; and accountable for all aspects of the work. RMT, JLF, MM:Acquisition and analysis of the data for the work; critical revision of the work for important intellectual content; final approval of the version to be published; and accountable for all aspects of the work. JMS, AMM, PR: Acquisition of the data for the work; critical revision of the work for important intellectual content; final approval of the version to be published; and accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests JEDA and YK are consultants for Penumbra, Inc., and Medtronic Neurovascular. All other authors do not have any competing interests related to the subject matter of this manuscript.

    • Patient consent Not required.

    • Ethics approval Abbott Northwestern Hospital Institutional Review Board.

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

    • Data sharing statement There is no data sharing agreement applicable to this study.