Abstract TP5: Long Term Experience Using the ADAPT Technique for the Treatment of Acute Ischemic Stroke

Abstract

Introduction: The ADAPT technique has been introduced as a simple and fast method for achieving good angiographic and clinical outcomes using large bore aspiration catheters. We present a single center’s long term experience with the ADAPT technique. Methods: Retrospective analysis from a prospectively maintained database was gathered on patients undergoing stroke thrombectomy with the ADAPT technique at the Medical University of South Carolina. Specific parameters captured included age, gender, NIHSS score at presentation, time to presentation from last normal, and modified Rankin Scale score at 90 day follow-up. Radiological and angiographic imaging was reviewed to document the location of the vascular occlusion, TICI flow post procedure, and procedural complications. Results: 175 consecutive patients who suffered an acute ischemic stroke treated with the ADAPT technique were reviewed. 88 were female, and the average age was 66.8 years. Patients presented with a mean NIHSS score of 15.6, and 69 patients received IV tPA. The average time from onset to puncture was 7.75 hours. The average time for recanalization was 40 minutes. TICI 2B or better recanalization was achieved in 166 (94.9%) patients. 90 day mRS on average was 2.7, and 82 (50.31%) patients had an mRS of 0-2 at 90 days. Direct aspiration alone was performed in 130 of cases, and 45 cases required the additional use of a stent retriever. There was no significant difference in presenting NIHSS, average time to presentation, average mRS at 90 days, or 90 day mortality between the two groups. Time to recanalization was 33.8 minutes for direct aspiration, as compared to 58 minutes in cases that required adjunct devices (p= 0.000036). 67 (63.21%) patients who underwent direct aspiration only achieved a good outcome at 90 days (mRS 0-2), compared to 15 (44.12%) who underwent adjunct therapies (p-value=0.021). Conclusions: The ADAPT technique is an effective method to achieve good clinical and angiographic outcomes. The ADAPT technique serves as a useful first line method for revascularization.