New neuroendovascular technique offers hope for stroke patients

A new neuroendovascular technique has shown promise in stroke patients with large-vessel clots.

The Medical University of South Carolina researchers reported impressive 90-day outcomes in patients with large-vessel ischemic stroke who underwent thrombectomy using a direct-aspiration, first pass technique (ADAPT).

Approximately 58 percent of stroke patients with a large-vessel clot removed using the technique achieved a good outcome at 90 days, defined as a Modified Rankin Score (mRS) of 0 to 2.

ADAPT aims to remove the clot in its entirety with a large-diameter aspiration catheter in a single pass. In contrast, stent retrievers, currently considered standard of care, frequently fragment the clot for removal and can require several passes.

"The goal in ADAPT is to take the largest-bore catheter available up to the blood clot and put suction where it's blocked and pull it out of the head to reestablish flow in that blood vessel," said co-author Aquilla S. Turk. If the first-pass attempt is unsuccessful, stent retrievers can still be used to remove the clot.

In the article, the investigators report the results of a retrospective study of 191 consecutive patients with acute ischemic stroke who underwent ADAPT at MUSC Health.

In 94.2 percent of patients, blood vessels were successfully opened, by direct aspiration alone in 145 cases and by the additional use of stent retrievers in another 43 cases. Good outcomes at 90 days (mRS, 0-2) were achieved in 57.7 percent of patients who were successfully revascularized with aspiration alone and in 43.2 percent of those who also required a stent retriever. The average time required to reopen the blocked blood vessels was 37.3 minutes, 29.6 minutes for direct aspiration alone and 61.4 minutes for cases that also required stent retrievers. Patients presented for thrombectomy on average 7.8 hours after stroke onset.

The study is published online by the Journal of Neurointerventional Surgery.