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Direct Aspiration Thrombectomy for Acute Stroke: Evolution of Technique and Evidence

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12 Strokes

Abstract

Direct aspiration, a thrombectomy approach that originally evolved from a modified stent retriever-based technique, is now accepted as a frontline modality. We outline the evolution of thrombectomy techniques leading to ADAPT (A Direct Aspiration First-Pass Technique), as well as the current literature to support its use.

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References

  1. Albers GW, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nogueira RG, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21.

    Article  PubMed  Google Scholar 

  3. Goyal M, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31.

    Article  PubMed  Google Scholar 

  4. Fransen PS, et al. MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 2014;15:343.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Saver JL, et al. Solitaire with the intention for thrombectomy as primary endovascular treatment for acute ischemic stroke (SWIFT PRIME) trial: protocol for a randomized, controlled, multicenter study comparing the solitaire revascularization device with IV tPA with IV tPA alone in acute ischemic stroke. Int J Stroke. 2015;10(3):439–48.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Turk AS, et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. 2013;6:231.

    Article  PubMed  Google Scholar 

  7. Alawieh A, et al. Lessons learned over more than 500 stroke thrombectomies using ADAPT with increasing aspiration catheter size. Neurosurgery. 2018;86:61.

    Google Scholar 

  8. Vargas J, et al. Long term experience using the ADAPT technique for the treatment of acute ischemic stroke. J Neurointerv Surg. 2017;9(5):437–41.

    Article  PubMed  Google Scholar 

  9. Vargas J, et al. Experience with A Direct Aspiration First Pass Technique (ADAPT) for thrombectomy in distal cerebral artery occlusions causing acute ischemic stroke. World Neurosurg. 2017;99:31–6.

    Article  PubMed  Google Scholar 

  10. Turk AS 3rd, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet. 2019;393(10175):998–1008.

    Article  PubMed  Google Scholar 

  11. Lapergue B, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial. JAMA. 2017;318(5):443–52.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bose A, et al. The Penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol. 2008;29(7):1409–13.

    Article  CAS  PubMed  Google Scholar 

  13. Nogueira RG, et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380(9849):1231–40.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tenser MS, Amar AP, Mack WJ. Mechanical thrombectomy for acute ischemic stroke using the MERCI retriever and Penumbra aspiration systems. World Neurosurg. 2011;76(6 Suppl):S16–23.

    Article  PubMed  Google Scholar 

  15. Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. AJNR Am J Neuroradiol. 2006;27(6):1177–82.

    CAS  PubMed  Google Scholar 

  16. Yoo AJ, et al. The penumbra stroke system: a technical review. J Neurointerv Surg. 2012;4(3):199–205.

    Article  PubMed  Google Scholar 

  17. Spiotta AM, et al. The versatile distal access catheter: the Cleveland Clinic experience. Neurosurgery. 2011;68(6):1677–86; discussion 1686.

    Article  PubMed  Google Scholar 

  18. Turk AS 3rd, et al. An investigation of the cost and benefit of mechanical thrombectomy for endovascular treatment of acute ischemic stroke. J Neurointerv Surg. 2014;6(1):77–80.

    Article  PubMed  Google Scholar 

  19. Turk AS, et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. 2018;10(Suppl 1):i20–5.

    Article  PubMed  Google Scholar 

  20. Frei D, et al. The SPEED study: initial clinical evaluation of the Penumbra novel 054 Reperfusion Catheter. J Neurointerv Surg. 2013;5(Suppl 1):i74–6.

    Article  PubMed  Google Scholar 

  21. Hui FK, et al. Merci retrievers as access adjuncts for reperfusion catheters: the grappling hook technique. Neurosurgery. 2012;70(2):456–60; discussion 460.

    Article  PubMed  Google Scholar 

  22. Turk A, et al. Initial experience with distal guide catheter placement in the treatment of cerebrovascular disease: clinical safety and efficacy. J Neurointerv Surg. 2012;5:247.

    Article  PubMed  Google Scholar 

  23. Turk AS, et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg. 2014;6(4):260–4.

    Article  PubMed  Google Scholar 

  24. Devlin TG, et al. The Merci retrieval system for acute stroke: the Southeast Regional Stroke Center experience. Neurocrit Care. 2007;6(1):11–21.

    Article  CAS  PubMed  Google Scholar 

  25. Delgado Almandoz JE, et al. Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg. 2016;8(11):1123–8.

    Article  PubMed  Google Scholar 

  26. Jovin TG, et al. Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods. Int J Stroke. 2017;12(6):641–52.

    Article  PubMed  Google Scholar 

  27. Campbell BC, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.

    Article  CAS  PubMed  Google Scholar 

  28. Jovin TG, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.

    Article  CAS  PubMed  Google Scholar 

  29. Powers WJ, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110.

    Article  PubMed  Google Scholar 

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Correspondence to Sami Al Kasab .

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Al Kasab, S., Spiotta, A.M. (2021). Direct Aspiration Thrombectomy for Acute Stroke: Evolution of Technique and Evidence. In: Hui, F.K., Spiotta, A.M., Alexander, M.J., Hanel, R.A., Baxter, B.W. (eds) 12 Strokes. Springer, Cham. https://doi.org/10.1007/978-3-030-56857-3_8

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