Clinical Research
Endovascular recanalization with a direct aspiration first-pass thrombectomy technique for acute cerebral artery occlusion
Zhang Heliang, Guo Zaiyu, Liu Meili, Hou Yanwei, Zhao Weihua, Zhao Wei, Li Bo, Tian Sisi
Published 2017-06-08
Cite as Chin J Neurol, 2017,50(06): 445-451. DOI: 10.3760/cma.j.issn.1006-7876.2017.06.009
Abstract
ObjectiveTo investigate the feasibility, safety and technical superiority of mechanical thrombectomy using a direct aspiration first-pass thrombectomy (ADAPT) in treatment of patients with acute cerebral artery occlusion.
MethodsA retrospective study was conducted on all patients with acute ischemic stroke treated with mechanical thrombectomy in our institution from January 2013 to August 2016. Patients using ADAPT or stent retriever as a first-line endovascular procedure were compared for clinical characteristics, procedural variables and clinical outcomes. The technical superiority of ADAPT was analyzed in depth.
ResultsDuring observation period, a total of 91 cases were performed endovascular treatment with mechanical thrombectomy. ADAPT was designed in 46 cases as a first-line endovascular procedure and was utilized in 38 cases (82.6%; ADAPT group), while primary stent retriever thrombectomy was performed in 21 patients(stent group). There was no significant difference in baseline clinical or radiographic factors between ADAPT and stent groups. Although rates of good neurological outcome (modified Rankin Scale(mRS) score≤2) at 90 days were similar between the ADAPT and stent groups (61%(23/38) vs 48%(10/21), P=0.247), National Institute of Health Stroke Scale (NIHSS) score at seven days (6.0(2.0, 9.3) vs 9.0(5.5, 18.5), Z=-2.031, P=0.021) and full recovery rate of neurological outcome (mRS score=0, 37%(14/38) vs 10%(2/21), P=0.022) were significantly better in the ADAPT group than in the stent group. There were no significant differences in rates of embolus to new territory (21%(8/38) vs 29%(6/21), P=0.365), Thrombolysis In Cerebral Infarction (TICI) 2b/3 grade revascularization (84%(32/38) vs 81%(17/21), P=0.507) and symptomatic intracerebral hemorrhage (0%(0/38) vs 10%(2/21), P=0.123) between the ADAPT and the stent groups, but the figures were better in the ADAPT group.
ConclusionsMechanical thrombectomy using ADAPT is feasible and safe compared with stent retriever, with higher full recovery rate of neurological outcome and better NIHSS score. It is a method worthy of further exploration for endovascular mechanical recanalization.
Key words:
Brain infarction; Thrombectomy; Suction; Stents
Contributor Information
Zhang Heliang
Department of Neurosurgery, TEDA Hospital, Tianjin 300457, China
Guo Zaiyu
Liu Meili
Hou Yanwei
Zhao Weihua
Zhao Wei
Li Bo
Tian Sisi
