E-153 Efficacy of the adapt technique with evolving ACE aspiration catheter technology as first-line treatment in patients with acute ischemic strokes treated with mechanical thrombectomy: the first pass effect with adapt

PurposeTo 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.MethodsWe 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.ResultsFifty-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).ConclusionUse 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.

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Mechanical thrombectomy as a first-line treatment for arterial occlusion

Seminars in Vascular Surgery ◽

10.1053/svas.2001.23169 ◽

2001 ◽

Vol 14 (2) ◽

pp. 123-131 ◽

Cited By ~ 14

Author(s):

Karthikeshwar Kasirajan ◽

John M. Marek ◽

Mark Langsfeld

Keyword(s):

Mechanical Thrombectomy ◽

Arterial Occlusion ◽

Line Treatment ◽

First Line ◽

First Line Treatment

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Stroke thrombectomy complication management

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017349 ◽

2021 ◽

pp. neurintsurg-2021-017349

Author(s):

Sara M Pilgram-Pastor ◽

Eike I Piechowiak ◽

Tomas Dobrocky ◽

Johannes Kaesmacher ◽

Juergen Den Hollander ◽

...

Keyword(s):

Treatment Efficacy ◽

Mechanical Thrombectomy ◽

Complication Management ◽

Line Treatment ◽

Large Vessel Occlusion ◽

First Line ◽

Invasive Treatment ◽

Vessel Occlusion ◽

Endovascular Mechanical Thrombectomy ◽

First Line Treatment

Endovascular mechanical thrombectomy (EVT) is widely accepted as the first-line treatment for acute ischemic stroke in patients with large vessel occlusion. Being an invasive treatment, this method is associated with various preoperative, perioperative, and postoperative complications. These complications may influence peri-interventional morbidity and mortality and therefore treatment efficacy and clinical outcome. The aim of this review is to discuss the most common types of complications associated with EVT, the probable mechanisms of injury, and effective methods to manage and prevent complications.

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Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system

BMC Neurology ◽

10.1186/s12883-020-02013-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jin Wook Choi ◽

Miran Han ◽

Jung Hyun Park ◽

Woo Sang Jung

Keyword(s):

Basilar Artery ◽

Mechanical Thrombectomy ◽

Treatment Method ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Procedure Time ◽

First Line ◽

Aspiration Thrombectomy ◽

First Pass ◽

First Line Treatment

Abstract Background A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO). Methods The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared. Results Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage. Conclusions Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.

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Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions

BioMed Research International ◽

10.1155/2017/2362769 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 13

Author(s):

Samuel Heller ◽

Jean-Claude Lubanda ◽

Petr Varejka ◽

Miroslav Chochola ◽

Pavel Prochazka ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Limb Ischemia ◽

Performance Outcomes ◽

Amputation Rate ◽

Acute Limb Ischemia ◽

Line Treatment ◽

First Line ◽

Invasive Treatment ◽

Percutaneous Mechanical Thrombectomy ◽

First Line Treatment

Purpose. To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. Methods. In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. Results. Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. Conclusion. Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.

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