ADAPT First-Line Strategy for MCA Mainstem Occlusion; Analysis for Optimal Salvage Therapy and its Related Factor |
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| Affiliation: | 1. Department of Neurology, University of Pecs, Medical School, Pecs, Hungary;2. Department of Anaesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary;3. Department of Immunology and Biotechnology, University of Pecs, Medical School, Pecs, Hungary;4. Salisbury NHS Foundation Trust, Salisbury, United Kingdom;5. Department of Radiology, University of Örebro, Örebro, Sweeden;6. Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary;1. Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia;2. The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia;3. Peninsula Clinical School, Central Clinical School, Monash University, VIC, Australia;4. Sunshine Coast Clinical School, School of Medicine, Griffith University, Birtinya, QLD, Australia;5. The University of Sydney, NSW, Australia;6. The George Institute for Global Health, Sydney NSW, Australia; and The George Institute for Global Health at Peking University Health Science Center, China;7. Department of Public Health, La Trobe University, Bundoora VIC, Australia;8. Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC; and Alfred Health, Melbourne, VIC, Australia;9. University of Newcastle, Newcastle, NSW, Australia;10. Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia;1. Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark;2. Department of Cardiology, Aalborg University Hospital, Denmark;3. Department of Neurology, Herlev-Gentofte University Hospital, Denmark;4. Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Denmark;5. Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark;6. Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark;7. Department of Cardiology, Herlev-Gentofte University Hospital, Denmark;8. Department of Clinical Research and Cardiology, Nordsjællands Hospital, Denmark;1. The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong;2. The School of Nursing and Midwifery, Queen''s University Belfast, Belfast, UK;1. The Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA;2. Angioma Alliance, Norfolk, Virginia, USA;3. Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA |
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| Abstract: | ObjectivesA direct first-pass aspiration technique (ADAPT) is an attractive interventional technique for mechanical thrombectomy (MT), which could achieve recanalization quickly and safely at a small amount of material resources. To clarify its usefulness, our ADAPT first-line strategy for middle cerebral artery (MCA)-mainstem occlusion was retrospectively analyzed.Materials and MethodsWe reviewed 54 consecutive patients who underwent MT for MCA-mainstem occlusion using ADAPT first-line strategy. A salvage procedure was concurrently conducted in cases that failed to achieve successful recanalization by ADAPT attempt alone. Procedural and clinical outcome were assessed in both ADAPT alone and Salvage groups. Further investigation was performed in cases that required salvage procedure to determine the reason, risk factors, and optimal procedure.ResultsForty-one patients (75.9%) were able to achieve successful recanalization with ADAPT technique alone. In salvage group, the procedural time was longer, and rates of successful recanalization were lower than in ADAPT-alone group. No significant difference in the rates of favorable outcomes was observed. Among 13 patients who required salvage therapy, the major reason (eight cases) was intra-procedural “thrombus distal migration”. Failure of recanalization was seen in two cases due to “inaccessibility”. In patients who had “thrombus distal migration”, occlusion in the proximal portion was more frequently observed than in patients who did not (p = 0.032, 63.6% vs. 23.3%).ConclusionsOur ADAPT first-line strategy for MCA-mainstem occlusion demonstrated favorable procedural and clinical outcomes, even in cases that required additional procedures. Further investigation and better understanding are required to refine this promising procedure. |
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