UOC di Neuroradiologia Diagnostica ed Interventistica, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
Unità di Radiologia Diagnostica ed Interventistica, Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
Radiol Med. 2020 Jan;125(1):57-65. doi: 10.1007/s11547-019-01069-x. Epub 2019 Aug 31.
A direct aspiration first pass technique (ADAPT) is an alternative technique as first-line thrombectomy for large vessel occlusion in acute ischemic stroke, still debated when compared to first-line stent retriever. To retrospectively evaluate technical and clinical outcomes of the ADAPT as first-line treatment for anterior circulation acute ischemic stroke with large-bore reperfusion catheters.
A multicentric data collection from 14 medical centers was retrospectively analyzed. Large-bore catheters had a distal diameter between 0.64 and 0.71 in; stent retriever was added when aspiration alone failed. Baseline characteristics, technical and clinical variables were collected, including NIHSS, thrombolysis in cerebral infarction (TICI), peri-procedural complications, 90-day mRS and 90-day mortality.
Overall, 501 patients were treated. No statistically significant difference in terms of baseline features or tPA administration was recorded between patients treated with ADAPT and with additional stent retriever. ADAPT alone was successful in achieving TICI ≥ 2b in 71.8% with a median of 1.55 aspiration attempts. In terms of TICI ≥ 2b, ADAPT alone was better than additional stent retriever (p < 0.001), while no statistical difference was achieved from catheter diameter. Embolization to a new territory was less frequent in ADAPT group (5.2 vs 18%; p = 0.0026). Patients treated with ADAPT alone had better clinical outcomes in terms of mRS ≤ 2 (p < 0.001).
ADAPT is a valid technique with respect to the rates of TICI 2b/3 recanalization and 90-day mRS scores. In this series, an attempt at recanalization with ADAPT with larger-bore reperfusion catheter may be warranted prior to stentriever thrombectomy.
直接抽吸首过技术（ADAPT）是急性缺血性脑卒中大血管闭塞的一线取栓替代技术，与一线支架取栓相比，其仍存在争议。本研究旨在回顾性评估使用大口径再通导管作为一线治疗前循环急性缺血性脑卒中的 ADAPT 的技术和临床结局。
对来自 14 家医疗中心的多中心数据进行回顾性分析。大口径导管的远端直径在 0.64 到 0.71 英寸之间；如果单独抽吸失败，则添加支架取栓。收集了基线特征、技术和临床变量，包括 NIHSS、脑梗死溶栓（TICI）、围手术期并发症、90 天 mRS 和 90 天死亡率。
总体而言，共治疗了 501 例患者。接受 ADAPT 治疗和额外支架取栓治疗的患者在基线特征或 tPA 给药方面无统计学差异。ADAPT 单独治疗可使 71.8%的患者达到 TICI≥2b，中位数抽吸尝试次数为 1.55 次。在 TICI≥2b 方面，ADAPT 单独治疗优于额外支架取栓（p<0.001），而导管直径无统计学差异。ADAPT 组新部位栓塞的发生率较低（5.2% vs. 18%；p=0.0026）。ADAPT 单独治疗的患者在 mRS≤2 方面具有更好的临床结局（p<0.001）。
ADAPT 是一种有效的技术，在 TICI 2b/3 再通率和 90 天 mRS 评分方面具有优势。在本系列中，在使用支架取栓之前，使用较大口径再通导管进行 ADAPT 再通尝试可能是合理的。
