We report our single center experience of endovascular treatment of stroke by a technique of direct aspiration with large bore catheter.Methods
From September 2013 to March 2014 we included prospectively on intent to treat 80 patients presenting with large vessels occlusion in the settings of acute ischemic stroke. The ADAPT technique was utilised in first intention in all patients and was associated with stentriever technique when necessary. Procedural and clinical data were collected for analysis.Results
Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 15 (1–26). The localization of arterial occlusion was the MCA in 40/80 (50%), the ICA in 10/80 (12.5%), a tandem occlusion in 24/80 (30%) and the vertebro basilar territory in 6/80 (7.5%). The aspiration technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 43% of cases (38/80). The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 87.5%. With ADAPT alone, the average time from groin puncture to at least TICI 2b recanalization was 37 min (from clot contact to recanalization: 17 min). Ninety day functional outcomes was available for 35 patients were 50% (modified Rankin Scale (mRS) 0–2) and 15% (mRS 6). For the overall series there were 8 cases (10%) of procedural complications (one non occlusive dissection 4 distal emboli, and 5 Subarachnoid haemorrhages) and 2 symptomatic intracerebral haemorrhages (2.5%).Discussion
The Aspiration technique utilising large bore aspiration catheters technique alone was effective in 43% of the cases being fast, safe and simple, nevertheless in our experience to achieve a recanalization rate of 87.5% it add to be completed by the use of stentrievers in the other cases. The relevance of this technique needs to studied in larger prospective multicentric studies.Disclosures
R. Blanc: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. 4; C; Lazarus. R. Fahed: None. H. Redjem: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. B. Bartolini: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. S. Pistocchi: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. M. Piotin: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. 4; C; Lazarus.