Contact aspiration compared to stent retriever as sole intention to treat large-vessel occlusion in ischemic stroke

Abstract

Background and purpose: A direct aspiration first-pass technique (ADAPT) was recently evaluated in three retrospective trials as the primary method for large-vessel recanalization in acute ischemic stroke. This study sought to evaluate the clinical and angiographic outcome of ADAPT when used as the first and only method of clot retrieval compared to the accepted mechanical approach. Materials and methods: Patients with acute ischemic stroke associated with large-vessel occlusion who underwent ADAPT as the first and only intention-to-treat endovascular approach in 2010–2017 were matched 1-to-2 with patients treated by stent retriever thrombectomy. Demographic, imaging, procedural, and clinical data were collected retrospectively for between-group analysis. Results: The study group included 39 patients (51% male) of mean age 67 years; median National Institute of Health Stroke Scale score was 16. Compared to the stent-retriever group (N = 80), the ADAPT group had a significantly shorter puncture-to-recanalization time (58 min vs 76 min, P = 0.05), higher rate of good recanalization (TICI 2B/3 95% vs 86%, P = 0.15), and significantly higher rate of early neurological improvement (64% vs 43% of patients, P < 0.03). Procedure-related symptomatic intracerebral hemorrhage occurred in 8 patients, all in the control group (P = 0.05). At 3 months, a favorable outcome (mRS ≤ 2) was documented in 58% of the ADAPT group and 32% of the control group (P = 0.005); the respective mortality rates were 5% and 18% (P < 0.05). Conclusions: ADAPT is a safe and an effective technique that has facilitated our approach to acute ischemic stroke thrombectomy, achieving better angiographic and clinical outcomes.

Keywords

• Acute stroke
• Endovascular recanalization
• Thrombectomy
• Aspiration catheter