Kaschner Marius Georg, Rubbert Christian, Caspers Julian, Karsten Jennifer, Kraus Bastian, Lee John-Ih, Gliem Michael, Jander Sebastian, Turowski Bernd
University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225, Düsseldorf, Germany.
University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225, Düsseldorf, Germany.
J Stroke Cerebrovasc Dis. 2019 Mar;28(3):640-648. doi: 10.1016/j.jstrokecerebrovasdis.2018.11.004. Epub 2018 Dec 19.
The benefit of the direct aspiration thrombectomy (ADAPT) technique for the treatment of ischemic stroke due to large vessel occlusion are challenged after publishing of the ASTER trial that failed to show superiority of ADAPT compared to stent retriever. Aim of the present single-center study was a retrospective evaluation of the ADAPT technique comparing our results with literature.
MATERIAL/METHODS: We retrospectively analyzed institutional data of stroke procedures in patients with mainstem occlusion of the middle cerebral artery treated between November 2016 and December 2017 with an initial attempt of manual thrombaspiration. Reperfusion rate (thrombolysis in cerebral infarction), procedural times, early clinical outcome and complications were recorded.
Forty patients were treated by using direct thrombaspiration in middle cerebral artery mainstem occlusion. Median age was 67.5 (±17.8) years (m = 27.5%). Median Baseline National Institutes of Health Stroke Scale score was 12 (IQR 7) preintervention and 3 (IQR 11) postintervention. Twenty-eight (70%) patients received intravenous thrombolysis. Successful recanalization (modified thrombolysis in cerebral infarction ≥ 2b) could be achieved in 85% with direct aspiration alone. Mean time from groin puncture to recanalization was 25.2 ± 14.3 minutes. Embolization to new territories occurred in 1 of 40 (2.5%) cases and symptomatic intracranial hemorrhage in 3 of 40 (7.5%). Nineteen of 40 (47.5%) patients achieved favorable outcome (modified Rankin scale 0-2) at discharge.
The ADAPT technique presented as a safe and efficient first-line recanalization strategy with good clinical outcome for treatment of acute ischemic stroke resulting from large vessel occlusions in this single-center study and review of the literature. However, the concept of ADAPT as an equivalent first-line approach to stent retriever thrombectomy has to be proven by future randomized studies.
在ASTER试验公布后，直接抽吸血栓切除术（ADAPT）技术用于治疗大血管闭塞所致缺血性卒中的益处受到质疑，该试验未能显示出ADAPT相对于支架取栓器的优越性。本单中心研究的目的是对ADAPT技术进行回顾性评估，并将我们的结果与文献进行比较。
材料/方法：我们回顾性分析了2016年11月至2017年12月间接受首次手动抽吸血栓治疗的大脑中动脉主干闭塞患者的卒中治疗机构数据。记录再灌注率（脑梗死溶栓）、手术时间、早期临床结局和并发症。
40例大脑中动脉主干闭塞患者接受了直接抽吸血栓治疗。中位年龄为67.5（±17.8）岁（男性占27.5%）。干预前美国国立卫生研究院卒中量表基线中位评分为12（四分位间距7），干预后为3（四分位间距11）。28例（70%）患者接受了静脉溶栓治疗。仅通过直接抽吸，85%的患者实现了成功再通（改良脑梗死溶栓≥2b）。从腹股沟穿刺到再通的平均时间为25.2±14.3分钟。40例中有1例（2.5%）发生栓塞至新区域，40例中有3例（7.5%）发生有症状颅内出血。40例中有19例（47.5%）患者出院时获得良好结局（改良Rankin量表0-2）。
在本单中心研究及文献回顾中，ADAPT技术是一种安全有效的一线再通策略，对治疗大血管闭塞所致急性缺血性卒中具有良好的临床结局。然而，ADAPT作为与支架取栓术等效的一线方法这一概念有待未来的随机研究证实。
