Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
J Neurointerv Surg. 2014 Apr 1;6(3):231-7. doi: 10.1136/neurintsurg-2013-010713. Epub 2013 Apr 27.
The development of new revascularization devices has improved recanalization rates and time but not clinical outcomes. We report our initial results with a new technique utilizing a direct aspiration first pass technique with a large bore aspiration catheter as the primary method for vessel recanalization.
A retrospective evaluation of a prospectively captured database of 37 patients at six institutions was performed on patients where the ADAPT technique was utilized. The data represent the initial experience with this technique.
The ADAPT technique alone was successful in 28 of 37 (75%) cases although six cases had large downstream emboli that required additional aspiration. Nine cases required the additional use of a stent retriever and one case required the addition of a Penumbra aspiration separator to achieve recanalization. The average time from groin puncture to at least Thrombolysis in Cerebral Ischemia (TICI) 2b recanalization was 28.1 min, and all cases were successfully revascularized. TICI 3 recanalization was achieved 65% of the time. On average, patients presented with an admitting National Institutes of Health Stroke Scale (NIHSS) score of 16.3 and improved to an NIHSS score of 4.2 by the time of hospital discharge. There was one procedural complication.
This initial experience highlights the fact that the importance of the technique with which new stroke thrombectomy devices are used may be as crucial as the device itself. The ADAPT technique is a simple and effective approach to acute ischemic stroke thrombectomy. Utilizing the latest generation of large bore aspiration catheters in this fashion has allowed us to achieve excellent clinical and angiographic outcomes.
新型血管再通装置的发展提高了再通率并缩短了再通时间，但并未改善临床结局。我们报告了一项新技术的初步结果，该技术采用大口径抽吸导管直接抽吸首次通过技术作为血管再通的主要方法。
对六家机构前瞻性收集的37例患者数据库进行回顾性评估，这些患者均采用了ADAPT技术。这些数据代表了该技术的初步经验。
仅ADAPT技术就在37例患者中的28例（75%）成功实施，尽管有6例出现较大的下游栓子，需要额外抽吸。9例需要额外使用支架取栓器，1例需要增加Penumbra抽吸分离器以实现再通。从腹股沟穿刺到至少达到脑缺血溶栓（TICI）2b级再通的平均时间为28.1分钟，所有病例均成功实现血管再通。65%的病例实现了TICI 3级再通。患者入院时美国国立卫生研究院卒中量表（NIHSS）评分平均为16.3分，出院时改善至NIHSS评分4.2分。有1例手术并发症。
这一初步经验凸显了一个事实，即使用新型卒中取栓装置的技术的重要性可能与装置本身一样关键。ADAPT技术是急性缺血性卒中取栓的一种简单有效的方法。以这种方式使用最新一代大口径抽吸导管使我们能够取得优异的临床和血管造影结果。
