Lessons Learned Over More than 500 Stroke Thrombectomies Using ADAPT With Increasing Aspiration Catheter Size

Neurosurgery ◽  
2018 ◽  
Author(s):  
Ali Alawieh ◽  
A Rano Chatterjee ◽  
Jan Vargas ◽  
M Imran Chaudry ◽  
Jonathan Lena ◽  
...  
Keyword(s):  
South Carolina ◽  
Standard Of Care ◽  
Multivariate Regression Analysis ◽  
Lessons Learned ◽  
Stent Retriever ◽  
Complication Rates ◽  
Procedure Time ◽  
University Of South Carolina ◽  
Endovascular Thrombectomy ◽  
The Impact

Abstract BACKGROUND Endovascular thrombectomy is currently the standard of care for acute ischemic stroke (AIS). Although earlier trials on endovascular thrombectomy were performed using stent retrievers, recently completed the contact aspiration vs stent retriever for successful revascularization (ASTER) and a comparison of direct aspiration versus stent retriever as a first approach (COMPASS) trials have shown the noninferiority of direct aspiration. OBJECTIVE To report the largest experience with ADAPT thrombectomy and compare the impact of advancement in reperfusion catheter technologies on outcomes. METHODS We reviewed a retrospective database of AIS patients who underwent ADAPT thrombectomy between January 2013 and November 2017 at the Medical University of South Carolina. Demographics and baseline characteristics, technical variables, and radiological and clinical outcomes were reviewed. RESULTS Among 510 patients (mean age: 67.7, 50.6% females), successful recanalization at first pass was achieved in 61.8%, and with aspiration only in 77.5%. Mean procedure time was 27.4 min, and the rate of good outcomes (mRS 0-2) at 90 d was 42.9%. The rate of recanalization with aspiration only was significantly higher, and procedure time was significantly lower in patients treated with larger catheters (ACE 064 and ACE 068) compared to smaller catheters (5 MAX and ACE, P < .05). There were no differences in complication rates or postoperative parenchymal hemorrhage across groups (P > .05); however, use of ACE 068 was an independent predictor of good outcomes at 90 d on multivariate regression analysis (odds ratio = 1.6, P < .05). CONCLUSION Refinement of ADAPT thrombectomy by incorporating reperfusion catheters with higher inner diameters and thus higher aspiration forces is associated with better outcomes, shorter procedure times, and lower likelihood of using additional devices without impacting complication rates.

Abstract WP14: Higher Aspiration Force Improves Technical Outcomes in ADAPT Thrombectomy for Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Reda M Chalhoub ◽  
Ali M Alawieh ◽  
Clayton Korson ◽  
Mohammad Anadani ◽  
Jonathan Lena ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Lower Number ◽  
Stent Retriever ◽  
Complication Rates ◽  
Procedure Time ◽  
Aspiration Thrombectomy ◽  
Patient Demographics ◽  
Significant Difference ◽  
Catheter Size ◽  
The Impact

Introduction: Aspiration thrombectomy using the direct aspiration at first pass technique (ADAPT) has been shown to be non-inferior to stent-retriever thrombectomy in ischemic stroke trials. Favorable outcomes after ADAPT are dependent on successful recanalization and lower number of aspiration attempts. We investigated the impact of aspiration force on technical and clinical outcomes of ADAPT by modulating two underlying determinants, the aspiration catheter size and the reperfusion pump power. Methods: We performed a retrospective analysis of patients undergoing ADAPT thrombectomy between 01/2018 and 02/2019. Patient treated using ADAPT were included irrespective of age, onset to groin or whether thrombolytic therapy was administered. Patient demographics and outcomes were reviewed from patient charts and thrombectomy procedure notes. Patients were dichotomized based on the reperfusion pump used (MAX, 28.5 inHb power vs ENGINE, 29.2 inHg power) and further split into the different reperfusion catheters used. Results: This study included 194 patients who underwent ADAPT thrombectomy during the study period with mean age of 69, and of which 48% were females. Comparing patients treated with two different reperfusion pumps, ENGINE (N=73) and MAX (N=118), similar rates of favorable outcomes measured by 90-day modified Rankin score (mRS) were observed. However, patients in the ENGINE groups had significantly shorter procedure time (20 vs 27 min, p<0.05), lower number of aspiration attempts (1.9 vs 2.2 p<0.05), and low rates of rescue stent retriever therapy (14% vs 33%, p<0.05). The use of ENGINE was an independent predictor of shorter procedure time (p<0.05) and lower rates of symptomatic hemorrhage (p<0.1) compared to MAX pump. There was no significant difference in procedure time and rates of functional outcomes among patients undergoing ADAPT using different sizes of large bore catheters ACE 60, ACE68 and Jet 7. Conclusion: Success of ADAPT thrombectomy is dependent on successful aspiration of the occluding clot, and is dependent on the aspiration force. Higher aspiration forces can be achieved by increasing the power of reperfusion pump leading to better technical outcomes without increased complication rates.

scholarly journals Lessons Learned from the Medical University of South Carolina Transdisciplinary Collaborative Center (TCC) in Precision Medicine and Minority Men’s Health

2020 ◽  
Vol 14 (6) ◽  
pp. 155798832097923
Author(s):  
Chanita Hughes Halbert ◽  
Caitlin G. Allen ◽  
Melanie Jefferson ◽  
Gayenell S. Magwood ◽  
Cathy Melvin ◽  
...  
Keyword(s):  
South Carolina ◽  
Precision Medicine ◽  
Synergistic Effects ◽  
Men’S Health ◽  
Lessons Learned ◽  
Men's Health ◽  
Dissemination And Implementation ◽  
University Of South Carolina ◽  
Minority Men ◽  
Medical University

The Transdisciplinary Collaborative Center (TCC) in Precision Medicine for Minority Men’s Health was established at the Medical University of South Carolina (MUSC) in 2015 to address disparities in the translation of precision medicine approaches among racial minority groups. This regional consortium focuses on three primary areas: (1) the development of a consortium of regional and national partners, (2) conducting transdisciplinary research examining synergistic effects of biological, social, physiological, and clinical determinants of chronic disease risks and outcomes, and (3) dissemination and implementation of precision medicine approaches, with an emphasis on reducing disparities in health care and outcomes among minority men. Given consistent calls to better translate precision medicine approaches and the focus of this consortium on addressing disparities among minority men, we provide an overview of our experience in developing the MUSC TCC, including barriers and facilitators to conducting translational research on minority men’s health issues in the context of precision medicine. Lessons learned and areas for improvement include providing enough time to create consistent partnerships and community engagement to improve recruitment and retention, identifying unique ways to engage diverse partners from across the region and nation, and better approaches to dissemination and communication for large partnerships focusing on precision medicine.

scholarly journals Decreasing procedure times with a standardized approach to ELVO cases

2016 ◽  
Vol 9 (1) ◽  
pp. 2-5 ◽  
Author(s):  
Ryan A McTaggart ◽  
Shadi Yaghi ◽  
Grayson Baird ◽  
Richard A Haas ◽  
Mahesh V Jayaraman
Keyword(s):  
Standard Of Care ◽  
Stent Retriever ◽  
Single Institution ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
Phase Group ◽  
Standardization Process ◽  
Group 2 ◽  
The Impact ◽  
Group 1

BackgroundEmbolectomy is the standard of care for emergent large vessel occlusion (ELVO), and needs to be done as quickly as possible for the best possible outcomes. Optimization of workflow and process is certainly paramount. One aspect of this is process improvement to standardize as much as possible the procedure in order to decrease variability among operators, which breeds familiarity for the entire team.ObjectiveTo evaluate the impact of a standardized approach to ELVO cases in decreasing times from groin puncture to first deployment of a stent-retriever and final recanalization.MethodsA retrospective review of 83 consecutive patients consisting of a pre-standardization phase (group 1) and those after standardization (group 2). The standardization process involved all three neurointerventional radiologists agreeing on a standard approach to the cases and to the equipment to be used. Times from groin puncture to first deployment of the stent-retriever and from puncture to final reperfusion were evaluated. Angiographic outcomes were scored using the Modified Thrombolysis in Cerebral Ischemia (mTICI) score. Complications from intracranial catheter manipulation (such as wire perforation) were also recorded. Clinical outcomes were assessed based on admission and discharge National Institute of Health Stroke Scale score.ResultsThere were 22 patients in group 1 and 61 patients in group 2. Mean times from groin puncture to first deployment were 39.8 min in group 1 and 20 min in group 2, a difference which was statistically significant (p<0.0001). Overall times from puncture to final recanalization were reduced from 68.2 to 37 min, also a statistically significant difference (p<0.001). There were no cases of intraprocedural complications such as wire perforation or subarachnoid hemorrhage.ConclusionsA standardized approach to the equipment used and process for ELVO cases at a single institution can dramatically reduce procedure times.

A new aspiration device equipped with a hydro-separator for acute ischemic stroke due to challenging soft and stiff clots

2021 ◽  
pp. 159101992110150
Author(s):  
Naoki Kaneko ◽  
Mahsa Ghovvati ◽  
Yutaro Komuro ◽  
Lea Guo ◽  
Kasra Khatibi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stent Retriever ◽  
Inverse Association ◽  
Success Rates ◽  
Endovascular Thrombectomy ◽  
Vitro Model ◽  
The Impact ◽  
Continuous Suction

Objective Fragile soft clots and stiff clots remain challenging in the treatment of acute ischemic stroke. This study aims to investigate the impact of clot stiffness on the efficacy of thrombectomy devices and a new aspiration catheter with a hydro-separator. Methods The Neurostar aspiration catheter has a novel hydro-separator technology that macerates clots by a stream of saline inside the catheter. The Neurostar catheter and two commercially available devices, the SOFIA aspiration catheter and Solitaire stent retriever, were tested in this study. We evaluated the efficacy of each device on clots with various stiffness in a simple in vitro model. We also assessed single-pass recanalization performance in challenging situations with large erythrocyte-rich clots and fibrin-rich clots in a realistic vascular model. Results We observed an inverse association between the clot stiffness and recanalization rates. The aspiration catheter, SOFIA ingested soft clots but not moderately stiff clots. When removing soft clots with the stent retriever, fragmentation was observed, although relatively stiff clots were well-integrated and removed. The Neurostar ingested soft clots similar to the aspiration catheter, and also aspirated stiff clots by continuous suction with hydro-separator. In the experiments with challenging clots, the Neurostar led to significantly higher recanalization rates than the stent retriever and aspiration catheter. Conclusions The stiffness of the clots affected the efficacy of endovascular thrombectomy based on the type of device. The Neurostar catheter with hydro-separator resulted in better success rates than a commercially available aspiration catheter and stent retriever in this experimental model.

scholarly journals Successes, challenges and lessons learned: Community-engaged research with South Carolina's Gullah population

2013 ◽  
Vol 6 ◽  
Author(s):  
Ida J. Spruill ◽  
Renata Serricchio Leite ◽  
Jyotika K. Fernandes ◽  
Diane L. Kamen ◽  
Marvella E. Ford ◽  
...  
Keyword(s):  
South Carolina ◽  
Vulnerable Populations ◽  
Health Research ◽  
Cultural Context ◽  
Interdisciplinary Teams ◽  
Lessons Learned ◽  
Cultural Issues ◽  
University Of South Carolina ◽  
Community Assets ◽  
Community Engaged Research

Engaging communities is highly recommended in the conduct of health research among vulnerable populations. The strength of community-engaged research is well documented and is recognised as a useful approach for eliminating health disparities and improving health equity. In this article, five interdisciplinary teams from the Medical University of South Carolina present their involvement with community-engaged research with a unique population of Gullah African Americans residing in rural South Carolina. Their work has been integrated with the nine established principles of community-engaged research: establishing clear goals, becoming knowledgeable about the community, establishing relationships, developing community self-determination, partnering with the community, maintaining respect, mobilising community assets, releasing control, and maintaining community collaboration. In partnership with a Citizen Advisory Committee, developed at the inception of the first community-engaged research project, the academic researchers have been able to build on relationships and trust with this population to sustain partnerships and to meet major research objectives over a 20-year period. Challenges observed include structural inequality, organisational and cultural issues, and lack of resources for building sustainable research infrastructure. Lessons learned during this process include the necessity for clearly articulated and shared goals, knowledge about the community culture, and embedding the cultural context within research approaches. Keywords: Engaged health research, vulnerable populations, longterm collaboration, South Carolina 'Gullah' communities

Abstract WP48: Impact of Rapid Complete Recanalization on Clinical Recovery in Cardioembolic Stroke Patients With M2 Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Junya Aoki ◽  
Ryutaro Kimura ◽  
Shinichiro Numao ◽  
Kazutaka Sawada ◽  
Takehiro Katano ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Data Bank ◽  
Multivariate Regression Analysis ◽  
Study Data ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Mca Occlusion ◽  
The Impact

Background and purpose: Recent study reported the impact of complete recanalization beyond significant recanalization. The main of present study is to investigate the impact of complete recanalization in stroke patients with distal (M2) middle cerebral artery (MCA) occlusion. Methods: From our prospective endovascular thrombectomy (EVT) registry and multicenter tPA trial (YAMATO study) data bank, data on M2 occlusion and treated with EVT and/or tPA were retrospectively reviewed. In the YAMATO study, all tPA patients were examined using MRA before and at 1 hour after tPA. Thus, we defined the complete recanalization as a modified TICI of 3 at the end of EVT or similar appearances of both MCA on MRA at 1 hour after tPA. Significant recanalization was TICI ≥2b or >50% recanalization of MRA. At 3 months, favorable outcome was defined as mRS ≤ 2. Result: Data on 122 patients with M2 occlusion (median age 79 [72-85] years; male, 69 [57%], NIHSS score 13 [8-19]) received tPA and/or EVT were analyzed. Onset-to-admission was calculated as 95 (52-189) minutes. Complete recanalization was achieved in 27 (22%) patients, and significant recanalization was in 75 (61%) patients. Neither EVT administration it self, tPA, combined EVT and tPA were related to the complete recanalization (p=0.383, 0,237 and 0.612). At 3 months onset, patients with complete recanalization at the end of EVT/tPA frequently had favorable outcome than those without it (75% vs. 43%, p=0.013), while significant recanalization did not statistically increase the rate of favorable outcome (52% vs. 46%, p=0.673). Age, NIHSS score, DWI-ASPECTS, and plasma levels of d-dimer and brain benign peptide were also related to the favorable outcome (0.031, <0.001, 0.005, 0.011, and 0.010). Finally, multivariate regression analysis found that complete recanalization was an independent parameter related to the favorable outcome (odd ratio, 5.0 95%CI [1.1-23.0], p=0.038) as well as DWI-ASPECTS (odds ratio, 2.1, 95%CI [1.2-3.3], p=0.001). Conclusion: Complete recanalization but not significant recanalization was a parameter associated with favorable outcome in M2 occlusion patients. The goal of recanalization therapy may be immediate and complete recanalization even in patients with distal MCA occlusion.

scholarly journals Using A Project To Add Practicality To Pedagogy

2007 ◽  
Vol 4 (2) ◽  
Author(s):  
Don Yates ◽  
Brian Smith
Keyword(s):  
South Carolina ◽  
Online Survey ◽  
Marketing Research ◽  
Secondary Data ◽  
Research Process ◽  
University Of South Carolina ◽  
City Tourism ◽  
Recent Project ◽  
The Impact ◽  
City Revitalization

In the marketing research class taught at University of South Carolina, Upstate School of Business and Economics, pedagogical emphasis is placed on the marketing research process as it relates to the policies and functions of the business enterprise. Historically, the marketing research project has been used in this undergraduate class to convey the nuances of market research to students. Participating students define the problem or opportunity for their client, determine budgets and timetables, select and design the research instrument(s), collect the data, organize and analyze the data, and present the project findings. A recent project, which involved work for the City of Sunshine, identified, measured, and analyzed specific “quality of life” variables and assessed the impact of the city’s revitalization efforts on the perceptions of its citizens. The study targeted three population sectors using questionnaires for data collection. The data was consolidated and analyzed by the students using WebSurveyor’s online survey tools. Comparative analysis was also performed using secondary data sources such as city tourism and visitor information, as well as sundry information from previous projects and similar city revitalization plans. The results of their analysis and corresponding conclusions are outlined in this paper.

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