Abstract
Background: To investigate the effect of the A Direct Aspiration First-Pass Thrombectomy (ADAPT) vs. Solumbra technique in the treatment of acute intracranial atherosclerosis-related large vessel occlusion (LVO).Methods: Patients with acute atherosclerosis-related LVO who had undergone endovascular treatment were retrospectively enrolled into two groups: The Solumbra and ADAPT groups. The clinical data were analyzed.Results: Patients (104) were enrolled with 48 in the Solumbra and 56 in the ADAPT group. The mean time from femoral access to recanalization was significantly (P < 0.05) shorter in the ADAPT than in the Solumbra group. The recanalization time at the first line was significantly shorter in the ADAPT group than in the Solumbra group (17 ± 10.21 vs. 26 ± 15.55 min, P = 0.02). However, the rate of switching to the alternative was significantly higher in the ADAPT group than that in the Solumbra group (46.42 vs. 33.33%, P = 0.01). Eighty-two patients had eventual recanalization, resulting in a final recanalization rate of 78.85%. At 3-month clinical follow-up for all patients, the good prognosis rate reached 51.92% with good prognosis in 24 patients (50%) in the Solumbra and 30 (53.57%) in the ADAPT group. The rate of symptomatic intracranial hemorrhage was 18.75% (n = 9) in the Solumbra and 19.64% (n = 11) in the ADAPT group. The mortality rate was 21.15% (22/104). Among 80 (76.92%) patients who had angiographic follow-up (3–30 months), five (6.25%) patients experienced in-stent stenosis, and two (2.5%) experienced asymptomatic stent occlusion.Conclusion: In patients with acute intracranial atherosclerosis-related LVO, clinical outcomes treated using the ADAPT technique are comparable with those using the Solumbra technique, and more patients need additional remedial measures if treated with the ADAPT technique.
Highlights
To investigate the effect of the A Direct Aspiration First-Pass Thrombectomy (ADAPT) vs. Solumbra technique in the treatment of acute intracranial atherosclerosis-related large vessel occlusion (LVO)
The inclusion criteria were patients with LVO, age ≥18 years, the time from disease onset to femoral artery puncture ≤8 h or between 8 and 24 h but consistent with the inclusion criteria of the DAWN experiment or DEFUSE-3 experiment [24], LVO confirmed by computed tomography angiography (CTA) or magnetic resonance angiography (MRA) including occlusion of the intracranial segment of the internal carotid artery (ICA), M1 segment of the middle cerebral artery (MCA), intracranial segments of the vertebral artery and basilar artery, atherosclerotic stenosis-related LVO, the modified Rankin scale score ≤2, and baseline score of the National Institutes of Health Stroke Scale (NIHSS) ≥6
Forty-eight patients were treated with the Solumbra technique, while 56 with the ADAPT (Figures 1, 2), and no significant (P > 0.05) differences were found in the age, sex distribution, and risk factors for atherosclerosis, or baseline NIHSS score between the two groups (Table 1)
Summary
To investigate the effect of the A Direct Aspiration First-Pass Thrombectomy (ADAPT) vs. Solumbra technique in the treatment of acute intracranial atherosclerosis-related large vessel occlusion (LVO). Since fast recanalization is the most important factor in determining the clinical outcomes, multiple endovascular management techniques are needed to recanalize intracranial atherosclerosis-related LVO compared with thromboembolism-related LVO. The Solumbra technique uses the Solitaire FR stent retriever for mechanical thrombectomy in combination with proximal thrombus aspiration using the Penumbra aspiration catheter [16,17,18]. This study was performed to compare the effect and clinical outcomes of the two techniques in Abbreviations: LVO, large vessel occlusion; ADAPT, A Direct Aspiration FirstPass Thrombectomy; CTA, computed tomography angiography; MRA, r magnetic resonance angiography; ICA, intracranial segment of the internal carotid artery; MCA, middle cerebral artery; mRS, modified Rankin scale score; NIHSS, National Institutes of Health Stroke Scale
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