![]() Inclusion criteria for endovascular therapy included LVO of anterior circulation as indicated by computed tomography (CT) angiography without evidence of major infarction (Alberta stroke program early CT score ≥6) on either CT or magnetic resonance imaging and a baseline National Institutes of Health stroke scale (NIHSS) score ≥6. The use of the pHLO AC for endovascular recanalization procedures was at the operator’s discretion at both centers. We retrospectively reviewed all consecutive cases in which ADAPT was performed using the pHLO AC in cases of acute thrombotic strokes at 2 comprehensive stroke centers (October 2019–November 2021). Antonio Cardarelli Hospital was obtained. The choice between these 2 options was at the discretion of the operator.Īpproval from the ethics committee of the A.O.R.N. If insufficient angiographic recanalization was achieved the aspiration attempt was repeated to engage the clot at the distal tip of the AC alternatively, an additional thrombectomy device was introduced. The catheter was then removed slowly with additional manual aspiration applied to the guide catheter. ![]() Aspiration was continued for approximately 4 minutes after flow had ceased. The procedure was performed using various microwires, including Traxcess 0.014 (MicroVention) and Synchro 2 Support 0.014 (Stryker).Īfter positioning the pHLO AC with the tip inside the proximal part of the thrombus, the microcatheter and microwire were removed and aspiration was initiated using a vacuum pump. A 125-cm pHLO AC was used in 15 of 25 cases (60%) a 135-cm pHLO AC was used in the remaining 10 cases (40%). The pHLO AC was advanced to the level of the occlusion, typically via a Headway 0.021 (MicroVention) or 0.025 Velocity microcatheter (Penumbra) and a 0.014-inch microwire. The guide catheter was placed in a distal location (e.g., in the petrous segment if possible).ĪDAPT was then performed. An 8F guide sheath (NeuronMAX 0.088 inch Penumbra or CEREBASE DA 0.090 inch Cerenovus) was inserted via a transfemoral approach into the internal carotid artery on the affected side. The interventional procedures were performed under general anesthesia or conscious sedation, depending on the local setting. ![]() The current study presents the combined results from 2 comprehensive stroke centers in which patients diagnosed with LVO of the anterior circulation underwent thrombectomies using ADAPT as a first-line approach with the pHLO 0.072-inch large-bore ACs (Phenox), a new larger bore AC that aims to maximize the inner diameter, which has recently emerged and is currently available for use. While the Contact Aspiration versus Stent Retriever for Successful Revascularization (ASTER) trial failed to confirm the superiority of this procedure with respect to safety, results from the COMPASS trial revealed noninferiority of ADAPT as a first-line procedure for thrombectomy in acute ischemic stroke specifically with respect to functional outcomes achieved when compared to stent retrievers as the first-line approach. ![]() Results from numerous single-center reports suggest that the aspiration approach may be less traumatic with minimal vessel wall damage and fewer symptomatic hemorrhages. This technique utilizes aspiration as the first approach to revascularize the occluded vessel, and if this strategy fails, then the aspiration catheter (AC) is used in conjunction with a stent retriever to obtain revascularization. Ī direct aspiration, first pass technique (ADAPT) has been proposed as a versatile, fast, and cost-effective approach to thrombectomy for acute ischemic stroke, with good recanalization rates and comparatively short procedure times and low associated costs. Endovascular thrombectomy has become part of the standard treatment for patients with acute ischemic stroke due to large vessel occlusion (LVO) in the anterior circulation.
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