Background: The improvement of revascularization techniques has decreased recanalization times, increased rates, and improved patient outcomes. We report our initial results using a double aspiration modification to the direct aspiration first pass technique as the primary method for vessel recanalization.
Methods: A retrospective evaluation of a prospectively captured group of 15 patients at one institution was performed on patients where the double aspiration modification of the ADAPT technique was used.
Results: The double aspiration technique by itself was adequate for recanalization of TICI 2b/3 in 13 of 14 (93%) cases without any instance of downstream emboli needing additional aspiration. Two cases needed the addition of a stent retriever to achieve recanalization. Average time from groin puncture to at least TICI 2b was 39 minutes, and all cases but one was successfully revascularized. TICI 3 recanalization was achieved 57% of the time. The average National Institutes of Health Stroke Scale (NIHSS) on admission was 14.3 and this improved to an average NIHSS of 7.25 prior to discharge. The modified Rankin Score at 90 days showed 7 of 14 (50%) with a score of one. There were no procedural complications.
Discussion: As previous studies have shown, aspiration technique is just as important as the aspiration device. This initial experience shows that the double-aspiration modification of the ADAPT technique is an effective method for mechanical thrombectomy in acute ischemic stroke. Utilizing the double-aspiration modification may decrease the incidence of downstream embolization, but further studies are needed to confirm this finding.