RESUMO
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.
Assuntos
Isquemia Encefálica/cirurgia , Catéteres , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Adulto , Idoso , Isquemia Encefálica/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão/instrumentação , Reperfusão/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/instrumentação , Resultado do TratamentoRESUMO
Following mechanical mitral valve replacement surgery, a 69-year-old woman had an ischemic stroke in the right middle cerebral artery territory. Mechanical thrombectomy showed the embolus to be a piece of chordae tendineae excised during the valve replacement surgery.
Assuntos
Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas , Infarto da Artéria Cerebral Média/etiologia , Valva Mitral , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Cordas Tendinosas/cirurgia , Feminino , HumanosRESUMO
Following mechanical mitral valve replacement surgery, a 69-year-old woman had an ischemic stroke in the right middle cerebral artery territory. Mechanical thrombectomy showed the embolus to be a piece of chordae tendineae excised during the valve replacement surgery.
Assuntos
Isquemia Encefálica/cirurgia , Cordas Tendinosas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Artéria Cerebral Média/cirurgia , Insuficiência da Valva Mitral/cirurgia , Acidente Vascular Cerebral/cirurgia , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Cordas Tendinosas/diagnóstico por imagem , Embolia/diagnóstico por imagem , Embolia/etiologia , Embolia/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca/tendências , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Trombectomia/métodosRESUMO
PURPOSE: To compare rates of symptomatic intracranial hemorrhage (SICH) and good clinical outcome at 90â 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 90â 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 90â 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 90â days in our cohort. CONCLUSIONS: In our cohort, the ADAPT technique was associated with significantly higher good clinical outcomes at 90â days in patients with acute ischemic stroke due to anterior circulation ELVOs treated with mechanical thrombectomy.