110 Noninferiority of a Direct Aspiration First-Pass Technique vs Stent Retriever Thrombectomy in Emergent Large-Vessel Intracranial Occlusions. (August 2016)

• Record Type: Journal Article
• Authors: Stapleton, Christopher J.; Torok, Collin M.; Patel, Aman B.
• Is Part Of: Clinical neurosurgery. Volume 63(2016)Supplement 1
• Publication Date: 2016-08
• Subjects: Nervous system -- Surgery -- Congresses; Neurosurgery; Nervous system -- Surgery; Neurologie; Congresses; Conference papers and proceedings; 617.48
• DOI: 10.1227/01.neu.0000489681.90969.21
• Languages: English
• ISSNs: 0069-4827

Abstract

Abstract : INTRODUCTION: Endovascular thrombectomy in patients with acute ischemic stroke caused by occlusion of proximal anterior circulation arteries has emerged as superior to standard medical therapy. While stent retriever thrombectomy with or without aspiration assistance was utilized in the 5 randomized controlled trials that demonstrated the efficacy of endovascular thrombectomy, several studies have also highlighted the efficacy of a direct-aspiration first-pass technique (ADAPT). METHODS: To compare the angiographic and clinical efficacy of ADAPT vs stent retriever thrombectomy in patients with emergent large-vessel occlusions (LVOs) of the anterior intracranial circulation, the records of 129 patients treated with endovascular thrombectomy from June 2012 to October 2015 were retrospectively reviewed. RESULTS: Within this cohort, 117 patients were eligible for evaluation. ADAPT was utilized in 47 patients, 20 (42.5%) of whom required eventual stent retriever thrombectomy ("ADAPT failure/stent retriever rescue"), while primary stent retriever thrombectomy was performed in 70 patients. Patients in the ADAPT group were slightly younger than patients in the stent retriever group (63.5 vs 69.4 years; P = .04); however, there were no other differences in baseline clinical or radiographic factors. Procedural time (54.0 vs 77.9 minutes; P < .01) and time to TICI 2b/3 recanalization (294.3 vs 346.7 minutes; P < .01) were significantly lower in the ADAPT vs the stent retriever group. Rates of TICI 2b/3 recanalization were similar between the ADAPT and stent retriever groups (82.9% vs 71.4%; P = .19). There were no differences in rates of symptomatic intracranial hemorrhage or procedural complications. Rates of good neurological outcome (modified Rankin Score 0-2) at 90 days were similar between the ADAPT and stent retriever groups (48.9% vs 41.4%; P = .45), even when accounting for the ADAPT failure/stent retriever rescue cohort. CONCLUSION: The present study confirms that ADAPT is noninferior to primary stent retriever thrombectomy for acute ischemic stroke due to emergent LVOs. Given reduced procedural times, time to TICI 2b/3 recanalization, and potentially lower resource utilization with equivalent outcomes, an initial attempt of ADAPT may be warranted prior to stent retriever thrombectomy.