Vargas Jan, Spiotta Alex M, Fargen Kyle, Turner Raymond D, Chaudry Imran, Turk Aquilla
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA.
World Neurosurg. 2017 Mar;99:31-36. doi: 10.1016/j.wneu.2016.11.035. Epub 2016 Nov 29.
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.
前后循环远端分支的血栓栓塞性闭塞可能会导致严重的临床缺陷。首次通过直接抽吸技术（ADAPT）是一种使用大口径导管处理大血管闭塞从而实现良好血管造影和临床结果的简单、快速的方法。我们展示了使用ADAPT治疗大脑远端动脉闭塞的结果。
ADAPT用于治疗35例急性缺血性卒中患者（14例女性，21例男性；平均年龄65.5岁±12.6岁），这些患者的大脑中动脉远端、大脑前动脉或大脑后动脉存在血栓。患者美国国立卫生研究院卒中量表平均评分为14.1±6.9；15例患者接受了静脉注射组织纤溶酶原激活剂。从发病到穿刺的平均时间为7.1小时±5.1小时。其中，28例（80%）为孤立的M2段闭塞，1例（2.9%）为孤立的A3段闭塞，6例（17.1%）为串联闭塞。
平均再通时间为35.7分钟±26.4分钟。34例患者（97.1%）实现了脑梗死溶栓2B级或更好，其中15例实现了脑梗死溶栓3级。单纯抽吸成功26例（77.1%），而7例（20%）需要额外的技术。32例患者获得了90天改良Rankin量表评分；59.4%的患者90天评分为0 - 2分。没有患者改良Rankin量表评分为6分。
急性远端前循环血栓栓塞性闭塞可以通过动脉内血栓切除术安全治疗。先前的研究已证明ADAPT在近端大血管闭塞治疗中的成功。本系列研究表明，ADAPT是在前循环和后循环远端分支进行血栓切除术的一种有效、安全的方法。
