Efficacy of ADAPT with large-bore reperfusion catheter in anterior circulation acute ischemic stroke: a multicentric Italian experience

Daniele Giuseppe Romano, Giulia Frauenfelder, Tommaso Casseri, Mariangela Piano, Sergio Vinci, Alessio Comai, Alessandro Stecco, Francesco Causin, Francesco Asteggiano, Aldo Paolucci, Chiara Comelli, Andrea Giorgianni, Luigi Cirillo, Giuseppe Ganci, Samuele Cioni, Antonio Pitrone, Guglielmo Pero, Rosario Papa, Mario Muto, Renato SaponieroSandra Bracco

Research output: Contribution to journalArticle

Abstract

Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)57-65
JournalRadiologia Medica
Volume125
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

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Cerebral Infarction
Reperfusion
Stents
Catheters
Stroke
Thrombectomy
Hong Kong
Mortality
Therapeutics

Keywords

  • Angiography
  • Catheter
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Efficacy of ADAPT with large-bore reperfusion catheter in anterior circulation acute ischemic stroke : a multicentric Italian experience. / Romano, Daniele Giuseppe; Frauenfelder, Giulia; Casseri, Tommaso; Piano, Mariangela; Vinci, Sergio; Comai, Alessio; Stecco, Alessandro; Causin, Francesco; Asteggiano, Francesco; Paolucci, Aldo; Comelli, Chiara; Giorgianni, Andrea; Cirillo, Luigi; Ganci, Giuseppe; Cioni, Samuele; Pitrone, Antonio; Pero, Guglielmo; Papa, Rosario; Muto, Mario; Saponiero, Renato; Bracco, Sandra.

In: Radiologia Medica, Vol. 125, No. 1, 01.01.2020, p. 57-65.

Research output: Contribution to journalArticle

Romano, DG, Frauenfelder, G, Casseri, T, Piano, M, Vinci, S, Comai, A, Stecco, A, Causin, F, Asteggiano, F, Paolucci, A, Comelli, C, Giorgianni, A, Cirillo, L, Ganci, G, Cioni, S, Pitrone, A, Pero, G, Papa, R, Muto, M, Saponiero, R & Bracco, S 2020, 'Efficacy of ADAPT with large-bore reperfusion catheter in anterior circulation acute ischemic stroke: a multicentric Italian experience', Radiologia Medica, vol. 125, no. 1, pp. 57-65. https://doi.org/10.1007/s11547-019-01069-x
Romano, Daniele Giuseppe ; Frauenfelder, Giulia ; Casseri, Tommaso ; Piano, Mariangela ; Vinci, Sergio ; Comai, Alessio ; Stecco, Alessandro ; Causin, Francesco ; Asteggiano, Francesco ; Paolucci, Aldo ; Comelli, Chiara ; Giorgianni, Andrea ; Cirillo, Luigi ; Ganci, Giuseppe ; Cioni, Samuele ; Pitrone, Antonio ; Pero, Guglielmo ; Papa, Rosario ; Muto, Mario ; Saponiero, Renato ; Bracco, Sandra. / Efficacy of ADAPT with large-bore reperfusion catheter in anterior circulation acute ischemic stroke : a multicentric Italian experience. In: Radiologia Medica. 2020 ; Vol. 125, No. 1. pp. 57-65.
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AU - Romano, Daniele Giuseppe

AU - Frauenfelder, Giulia

AU - Casseri, Tommaso

AU - Piano, Mariangela

AU - Vinci, Sergio

AU - Comai, Alessio

AU - Stecco, Alessandro

AU - Causin, Francesco

AU - Asteggiano, Francesco

AU - Paolucci, Aldo

AU - Comelli, Chiara

AU - Giorgianni, Andrea

AU - Cirillo, Luigi

AU - Ganci, Giuseppe

AU - Cioni, Samuele

AU - Pitrone, Antonio

AU - Pero, Guglielmo

AU - Papa, Rosario

AU - Muto, Mario

AU - Saponiero, Renato

AU - Bracco, Sandra

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N2 - Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.

AB - Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.

KW - Angiography

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KW - Stroke

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