Factors associated with successful revascularization using the aspiration component of ADAPT in the treatment of acute ischemic stroke.
BACKGROUND
ADAPT (a direct aspiration first pass technique) has been shown to be fast, cost-effective, and associated with excellent angiographic and clinical outcomes in the treatment of acute ischemic stroke (AIS).


OBJECTIVE
To identify any and all preoperative factors that are associated with successful revascularization using aspiration alone.


METHODS
A retrospective review of 76 patients with AIS treated with thrombectomy was carried out. Cohort 1 included cases in which aspiration alone was successful (Thrombolysis in Cerebral Infarction 2b or 3). Cohort 2 included cases in which aspiration was unsuccessful or could not be performed despite an attempt.


RESULTS
There was no difference between cohorts in gender, race, medications, National Institute of Health Stroke Scale score, IV tissue plasminogen activator, site or side of the occlusion, dense vessel sign, aortic arch type, severe stenosis, clot length, operator years of experience, and guide/aspiration catheters used. Patients in cohort 1 were on average younger (66.5 vs 74.1 years, p=0.025). There was a trend for more patients in cohort 2 to have atrial fibrillation/arrhythmias (62.5% vs 45.5%, p=0.168) and have a cardiogenic stroke etiology (78.1% vs 56.8%, p=0.086). There was also a trend for more reverse curves (2.3 vs 1.7, p=0.107), larger vessel diameter (3.26 mm vs 2.88 mm, p=0.184), larger vessel-to-catheter ratio (2.09 vs 1.87, p=0.192), and worse clot burden score (5.38 vs 6.68, p=0.104) in cohort 2.


CONCLUSIONS
Aspiration success was associated with younger age. Our findings suggest that ADAPT can be used for the vast majority of patients but it may be beneficial to use a different method first in the elderly.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Justin R
JR
Mascitelli
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Christopher P
http://orcid.org/0000-0003-4604-8205
CP
Kellner
University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA.
Chesney S
http://orcid.org/0000-0002-4846-7860
CS
Oravec
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Reade A
RA
De Leacy
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Eric K
EK
Oermann
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Kurt
K
Yaeger
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Srinivasan
S
Paramasivam
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Johanna T
JT
Fifi
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J
J
Mocco
D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
Stroke; Thrombectomy