Medical Scientist Training Program, Medical University of South Carolina, Charleston, South Carolina.
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
Neurosurgery. 2020 Jan 1;86(1):61-70. doi: 10.1093/neuros/nyy444.
Endovascular thrombectomy is currently the standard of care for acute ischemic stroke (AIS). Although earlier trials on endovascular thrombectomy were performed using stent retrievers, recently completed the contact aspiration vs stent retriever for successful revascularization (ASTER) and a comparison of direct aspiration versus stent retriever as a first approach (COMPASS) trials have shown the noninferiority of direct aspiration.
To report the largest experience with ADAPT thrombectomy and compare the impact of advancement in reperfusion catheter technologies on outcomes.
We reviewed a retrospective database of AIS patients who underwent ADAPT thrombectomy between January 2013 and November 2017 at the Medical University of South Carolina. Demographics and baseline characteristics, technical variables, and radiological and clinical outcomes were reviewed.
Among 510 patients (mean age: 67.7, 50.6% females), successful recanalization at first pass was achieved in 61.8%, and with aspiration only in 77.5%. Mean procedure time was 27.4 min, and the rate of good outcomes (mRS 0-2) at 90 d was 42.9%. The rate of recanalization with aspiration only was significantly higher, and procedure time was significantly lower in patients treated with larger catheters (ACE 064 and ACE 068) compared to smaller catheters (5 MAX and ACE, P < .05). There were no differences in complication rates or postoperative parenchymal hemorrhage across groups (P > .05); however, use of ACE 068 was an independent predictor of good outcomes at 90 d on multivariate regression analysis (odds ratio = 1.6, P < .05).
Refinement of ADAPT thrombectomy by incorporating reperfusion catheters with higher inner diameters and thus higher aspiration forces is associated with better outcomes, shorter procedure times, and lower likelihood of using additional devices without impacting complication rates.
血管内血栓切除术目前是急性缺血性脑卒中（AIS）的标准治疗方法。尽管之前的血管内血栓切除术试验使用了支架取栓器，但最近完成的接触抽吸与支架取栓器用于成功再通（ASTER）和直接抽吸与支架取栓器作为首选方法的比较（COMPASS）试验表明直接抽吸具有非劣效性。
报告 ADAPT 血栓切除术的最大经验，并比较再灌注导管技术的进步对结果的影响。
我们回顾了 2013 年 1 月至 2017 年 11 月期间在南卡罗来纳医科大学接受 ADAPT 血栓切除术的 AIS 患者的回顾性数据库。评估了人口统计学和基线特征、技术变量以及影像学和临床结果。
在 510 例患者中（平均年龄：67.7 岁，50.6%为女性），首次通过时实现了 61.8%的再通，仅通过抽吸实现了 77.5%的再通。平均手术时间为 27.4 分钟，90 天的良好结局（mRS 0-2）率为 42.9%。与较小的导管（5 MAX 和 ACE）相比，使用较大导管（ACE 064 和 ACE 068）的患者再通率更高，手术时间更短（P<.05）。各组之间的再通率或术后实质内出血无差异（P>.05）；然而，多变量回归分析显示，使用 ACE 068 是 90 天良好结局的独立预测因素（比值比=1.6，P<.05）。
通过结合内径更大、抽吸力更高的再灌注导管来改进 ADAPT 血栓切除术，与更好的结果、更短的手术时间以及使用额外设备的可能性降低相关，而不会影响并发症发生率。
