Experience with A Direct Aspiration First Pass Technique (ADAPT) for Thrombectomy in Distal Cerebral Artery Occlusions Causing Acute Ischemic Stroke

• Published in: World neurosurgery 2017-03, Vol.99, p.31-36
• Main Authors: Vargas, Jan, Spiotta, Alex M., Fargen, Kyle, Turner, Raymond D., Chaudry, Imran, Turk, Aquilla
• Format: Article
• Language: English
• Subjects: Acute ischemic stroke; Adult; Aged; Aged, 80 and over; Cerebral Revascularization - methods; Distal cerebral artery; Female; Humans; Intracranial Thrombosis - complications; Intracranial Thrombosis - diagnostic imaging; Intracranial Thrombosis - surgery; Male; Middle Aged; Occlusion; Retrospective Studies; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - prevention & control; Thrombectomy; Thrombectomy - methods; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.11.035

Thromboembolic occlusion of distal branches in anterior and posterior circulation may produce severe clinical deficits. A Direct Aspiration at first Pass Technique (ADAPT) is a simple, fast method for achieving good angiographic and clinical outcomes using large-bore catheters in large vessel occlusions. We present our results using ADAPT with distal cerebral artery occlusions. ADAPT was used to treat 35 patients (14 women, 21 men; average age 65.5 years ± 12.6) with acute ischemic stroke with thrombus in the distal middle cerebral artery, anterior cerebral artery, or posterior cerebral artery. Patients presented with a mean National Institutes of Health Stroke Scale score of 14.1 ± 6.9; 15 patients received intravenous tissue plasminogen activator. Mean time from onset to puncture was 7.1 hours ± 5.1. Of patients, 28 (80%) presented with isolated M2 segment occlusions, 1 (2.9%) presented with isolated A3 segment occlusion, and 6 (17.1%) presented with tandem occlusions. Mean time to recanalization was 35.7 minutes ± 26.4. A thrombolysis in cerebral infarction grade 2B or better was achieved in 34 patients (97.1%), with 15 achieving a thrombolysis in cerebral infarction 3. Aspiration alone was successful in 26 cases (77.1%), whereas 7 (20%) required additional techniques. A 90-day modified Rankin Scale score was available in 32 patients; 59.4% had a 90-day score of 0–2. No patients had a modified Rankin Scale score of 6. Acute distal anterior circulation thromboembolic occlusions may be treated safely with intraarterial thrombectomy. Prior studies have demonstrated the success of ADAPT in proximal large vessel occlusions. This series suggests that ADAPT is an effective, safe method for performing thrombectomy in distal branches of anterior and posterior circulation.