Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
J Neurointerv Surg. 2014 May;6(4):260-4. doi: 10.1136/neurintsurg-2014-011125. Epub 2014 Feb 25.
The development of new revascularization devices has improved recanalization rates and time, but not clinical outcomes. We report a prospectively collected clinical experience with a new technique utilizing a direct aspiration first pass technique with large bore aspiration catheter as the primary method for vessel recanalization.
98 prospectively identified acute ischemic stroke patients with 100 occluded large cerebral vessels at six institutions were included in the study. The ADAPT technique was utilized in all patients. Procedural and clinical data were captured for analysis.
The aspiration component of the ADAPT technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 78% of cases. The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 95%. The average time from groin puncture to at least TICI 2b recanalization was 37 min. A 5MAX demonstrated similar success to a 5MAX ACE in achieving TICI 2b/3 revascularization alone (75% vs 82%, p=0.43). Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 17.0 (12.0-21.0) and improved to a median NIHSS score at discharge of 7.3 (1.0-11.0). Ninety day functional outcomes were 40% (modified Rankin Scale (mRS) 0-2) and 20% (mRS 6). There were two procedural complications and no symptomatic intracerebral hemorrhages.
The ADAPT technique is a fast, safe, simple, and effective method that has facilitated our approach to acute ischemic stroke thrombectomy by utilizing the latest generation of large bore aspiration catheters to achieve previously unparalleled angiographic outcomes.
新的血运重建装置的发展提高了再通率和时间，但并未改善临床结局。我们报告了一项使用新的技术的前瞻性临床经验，该技术利用直接抽吸首过技术和大口径抽吸导管作为主要的血管再通方法。
在六个机构中，共有 98 例前瞻性诊断为急性缺血性脑卒中的患者，其 100 个闭塞的大血管接受了治疗。所有患者均采用 ADAPT 技术。采集了手术和临床数据进行分析。
ADAPT 技术中的抽吸部分单独成功地使 78%的病例达到血栓切除术溶栓分级（Thrombolysis in Cerebral Infarction，TICI）2b 或 3 级再通。支架取栓器的额外使用将 TICI 2b/3 级再通率提高至 95%。从股动脉穿刺到至少 TICI 2b 再通的平均时间为 37 分钟。5MAX 与 5MAX ACE 单独实现 TICI 2b/3 级再通的成功率相似（75%比 82%，p=0.43）。患者入院时的中位国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分为 17.0（12.0-21.0），出院时中位数降为 7.3（1.0-11.0）。90 天的功能结局为 40%（改良 Rankin 量表（modified Rankin Scale，mRS）0-2）和 20%（mRS 6）。有 2 例手术并发症，无症状性颅内出血。
ADAPT 技术是一种快速、安全、简单和有效的方法，它利用最新一代大口径抽吸导管实现了以前无法达到的血管造影结果，从而促进了我们对急性缺血性脑卒中取栓术的处理方法。
