Experience Of Single-center Of ADAPT In Patients With Acute Occlusion Of Large Vessels

Objective:Five Randomized controlled studies published on The New England Journal of Medicine since 2014 established the efficacy and safety of mechanical thrombectomy in acute ischemic stroke patients with early intracranial large vessel occlusion.Most of them used stent retrievers in mechanical thrombectomy procedure.Recently,number of studies have involved a direct aspiration first-pass Technique(ADAPT)because of the improvement in catheter production and operating technique.Since the second half of 2018 when Penumbra system was introduced to China,our center has applied ADAPT in a part of acute ischemic stroke patients with intracranial large vessel occlusion.This single-center retrospective study aimed to analysis the safety and efficacy of ADAPT in acute ischemic stroke patients with intracranial large vessel occlusion.Method:A retrospective analysis was performed on 62 patients with acute large vessel occlusion who were admitted to the department of neurology of the second affiliated hospital of soochow university from August 2018 to April 2019 and underwent mechanical thrombectomy by ADAPT.Eligible participants were ischemic stroke patients with acute occlusion in internal carotid artery,M1-M2 of middle cerebral artery and basilar artery.Efficacy and safety were evaluated by immediate revascularization of target vessels,symptomatic intracranial hemorrhage(sICH)within 72 hours after thrombectomy,favorable prognosis(Modified Rankin Scale score 0-2)at 90 days and stroke-relevant mortality or all-cause mortality 90 days after stroke onset.Result:57 patients reached Thrombolysis in Cerebral Infarction(TICI)2b-3,accounting for 92.0%(46.8%mTICI 2b,45.2%mTICI3).19 patients(30.6%)had a good functional prognosis at 90 days.The aspiration component of the ADAPT technique alone was successful in achieving TICI 2b-3 revascularization in 38 cases(61.3%),24 cases take additional use of stent retrievers to improve the TICI 2b/3 revascularization rate.11 cases died of all causes at 90 days(17.7%),23 cases had hemorrhagic transformation within 72 hours,and 10 cases was symptomatic intracranial hemorrhage.The percentage of patients with good prognosis in 90 days was higher in group of bridging thrombolysis than direct mechanical thrombectomy(P=0.055).NIHSS score(P=0.017),symptomatic intracranial hemorrhage(P=0.022)and systolic pressure(P=0.027)were independent risk factors of bad prognosis.Conclusion:The efficacy of ADAPT in the treatment of ischemic stroke patients with acute large vessel occlusion in our center are consistent with the multi-center studies abroad.ADAPT can be the preferred method for mechanical thrombectomy of acute ischemic stroke.NIHSS score,symptomatic intracranial hemorrhage and systolic pressure were independent risk factors of bad prognosis.