Purpose To compare rates of symptomatic intracranial hemorrhage (SICH) and good clinical outcome at 90 days in patients with ischemic strokes from anterior circulation emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy using either Solumbra or A Direct Aspiration first-Pass Thrombectomy (ADAPT) techniques.
Methods We compared clinical characteristics, procedural variables, and clinical outcomes in patients with anterior circulation ELVOs treated with mechanical thrombectomy using either a Solumbra or ADAPT technique at our institution over a 38-month period. SICH was defined using the SITS-MOST criteria. A good clinical outcome was defined as a modified Rankin Scale score of 0–2 at 90 days.
Results One hundred patients were included, 55 in the Solumbra group and 45 in the ADAPT group. Patients in the ADAPT group had higher National Institutes of Health Stroke Scale (NIHSS) (19.2 vs 16.8, p=0.02) and a higher proportion of internal carotid artery terminus thrombi (42.2% vs 20%, p=0.03) than patients in the Solumbra group. Patients in the ADAPT group had a trend toward a lower rate of SICH than patients in the Solumbra group (2.2% vs 12.7%, p=0.07). Patients in the ADAPT group had a significantly higher rate of good clinical outcome at 90 days than patients in the Solumbra group (55.6% vs 30.9%, p=0.015). Use of the ADAPT technique (OR 6 (95% CI 1.0 to 31.2), p=0.049) was an independent predictor of a good clinical outcome at 90 days in our cohort.
Conclusions In our cohort, the ADAPT technique was associated with significantly higher good clinical outcomes at 90 days in patients with acute ischemic stroke due to anterior circulation ELVOs treated with mechanical thrombectomy.
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Contributors JEDA: Study design, data collection and analysis, statistical analysis, manuscript preparation, manuscript editing and guarantor of the whole study. YK: Study design, data collection and analysis, media editing, manuscript editing. MLY: Study design, data analysis, manuscript editing. JLF: Data collection and analysis, statistical analysis, media editing, manuscript editing. JMS and AMM: Data collection, manuscript editing. THH: Data collection and analysis. PR: Data collection and analysis, manuscript editing. MM and RMT: Data analysis, manuscript editing.
Competing interests JEDA and YK have consulting agreements with Medtronic Neurovascular and Penumbra.
Ethics approval Ethics approval was obtained from the Abbott Northwestern Hospital IRB.
Provenance and peer review Not commissioned; externally peer reviewed.