Abstract
Background: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. Methods: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. Results: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel’s diameter positively predicted SS result (odd ratio (OR) 1.12, confidence of interval (CI) 95% 1.03–1.22; p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2–109.0) vs. 40.0 min (CI 95% 35.0–45.2); p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4–387.0) vs. 311.4 min (CI 95% 285.5–338.7); p = 0.23). Conclusion: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel’s diameter positively predicted recourse to SS.
Highlights
Between 2015 and 2016, six randomized control trials (MR CLEAN, ESCAPE, EXTENDIA, SWIFT-PRIME, REVASCAT and THRACE trials) showed positive results in favor of mechanical thrombectomy (MT) for acute stroke management [1], confirmed by the metaanalysis of the HERMES collaboration (odd ratio (OR) 2.49 (confidence of interval (CI)95% 1.76–3.53) for reducing disability at 90 days) [2]
The aim of our study was to evaluate the impact of switching from ADAPT to Solumbra on the successful revascularization in a hub center for cerebrovascular disease treatment
24 h service) to November 2019, 935 consecutive patients were admitted to the Stroke
Summary
Between 2015 and 2016, six randomized control trials (MR CLEAN, ESCAPE, EXTENDIA, SWIFT-PRIME, REVASCAT and THRACE trials) showed positive results in favor of mechanical thrombectomy (MT) for acute stroke management [1], confirmed by the metaanalysis of the HERMES collaboration (odd ratio (OR) 2.49 (confidence of interval (CI). 95% 1.76–3.53) for reducing disability at 90 days) [2]. In 2019, the COMPASS trial [3].
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