Factors associated with successful revascularization using the aspiration component of ADAPT in the treatment of acute ischemic stroke. (17th June 2016)

• Record Type: Journal Article
• Authors: Mascitelli, Justin R; Kellner, Christopher P; Oravec, Chesney S; De Leacy, Reade A; Oermann, Eric K; Yaeger, Kurt; Paramasivam, Srinivasan; Fifi, Johanna T; Mocco, J
• Is Part Of: Journal of neurointerventional surgery. Volume 9:Number 7(2017)
• Page Start: 636
• Page End: 640
• Publication Date: 2016-06-17
• Subjects: Stroke -- Thrombectomy; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2016-012439
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: ADAPT (a direct aspiration first pass technique) has been shown to be fast, cost-effective, and associated with excellent angiographic and clinical outcomes in the treatment of acute ischemic stroke (AIS). Objective: To identify any and all preoperative factors that are associated with successful revascularization using aspiration alone. Methods: A retrospective review of 76 patients with AIS treated with thrombectomy was carried out. Cohort 1 included cases in which aspiration alone was successful (Thrombolysis in Cerebral Infarction 2b or 3). Cohort 2 included cases in which aspiration was unsuccessful or could not be performed despite an attempt. Results: There was no difference between cohorts in gender, race, medications, National Institute of Health Stroke Scale score, IV tissue plasminogen activator, site or side of the occlusion, dense vessel sign, aortic arch type, severe stenosis, clot length, operator years of experience, and guide/aspiration catheters used. Patients in cohort 1 were on average younger (66.5 vs 74.1 years, p=0.025). There was a trend for more patients in cohort 2 to have atrial fibrillation/arrhythmias (62.5% vs 45.5%, p=0.168) and have a cardiogenic stroke etiology (78.1% vs 56.8%, p=0.086). There was also a trend for more reverse curves (2.3 vs 1.7, p=0.107), larger vessel diameter (3.26 mm vs 2.88 mm, p=0.184), larger vessel-to-catheter ratio (2.09 vs 1.87, p=0.192), and worse clot burden score (5.38 vs 6.68, p=0.104) in cohort 2. Conclusions: Aspiration success was associated with younger age. Our findings suggest that ADAPT can be used for the vast majority of patients but it may be beneficial to use a different method first in the elderly.