Introduction The direct aspiration first pass technique (ADAPT) has been introduced as a rapid and safe endovascular treatment strategy in patients with ischemic stroke.
Objective To determine the technical feasibility, safety, and functional outcome with ADAPT using the new large-bore 6F SOFIA Plus catheter.
Methods A retrospective analysis of prospectively collected data from six university hospitals was performed. The following parameters of all acute stroke procedures (June 2015– January 2016) using the SOFIA Plus catheter were analyzed: accessibility of the thrombus with the catheter, recanalization success (Thrombolysis in Cerebral Infarction ≥2b), time to recanalization, procedure-related complications. Furthermore, National Institutes of Health Stroke Scale (NIHSS) scores at presentation and discharge and the modified Rankin scale (mRS) score at 90 days were recorded.
Results 85 patients were treated using the SOFIA Plus catheter. The occlusion site was the anterior circulation in 94.1%. Median baseline NIHSS score was 18. In 64.7%, ADAPT alone was successful after a median procedure time of 21 min. With additional use of stent retrievers in the remaining cases, the recanalization rate was 96.5%. No catheter-related complications such as dissections were observed. Thrombus migration to a new vascular territory occurred in 4.7% and symptomatic hemorrhage in 4.7%. After 3 months, mRS 0–2 was achieved in 49.4%. Mortality rate was 20%.
Conclusions In the majority of cases, thrombus aspiration using the SOFIA Plus catheter results in successful recanalization after a short procedure time. With additional use of stent retrievers, a high recanalization rate can be achieved (96.5%). The complication rate was in line with those of previous publications.
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Contributors MAM, SS: study conception and design, interventions, acquisition of data, analysis and interpretation of data, drafting of the manuscript; CK, AK, EB, MS, MM, MW, JT, MK-O, WW, AM, MB: study conception and design, interventions, acquisition of data, critical revision of the manuscript.
Competing interests MAM: has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman, Covidien, MicroVention, Phenox, and Stryker; MS: congress support from MicroVention, Medtronic, and Stryker, outside the submitted work; MW: has been working as a consultant for Stryker Neurovascular, has received reimbursement for lectures or travel support from Bracco, Covidien, Siemens, Stryker Neurovascular, has received grants for research projects or educational exhibits from Abbott, ab medica, Acandis, Bayer, Bracco, B Braun, Codman Neurovascular, Covidien, Dahlhausen, MicroVention, Penumbra, Phenox, Philips, Siemens, SilkRoad Medical, St Jude, Stryker Neurovascular; JT: educational grants from Medtronic, Bracco, Guerbet, and Johnson Johnson, travel grants (conferences) from MicroVention, Stryker; MK-O: grants from MicroVention/Terumo, during the conduct of the study; WW: consultant for MicroVention/Terumo; AM: consultancy for Neuravi, Penumbra, and Sequent Medical, modest honoraria; MB: board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman.
Ethics approval Approval of the local ethics committees of the participating centers was obtained.
Provenance and peer review Not commissioned; externally peer reviewed.