Manual thromboaspiration technique as a first approach for endovascular stroke treatment: A single-center experience.
BACKGROUND
For intracranial large vessel occlusion in acute ischemic stroke (AIS), a high degree of revascularization in the minimal amount of time predicts good outcomes. Recently, different studies have shown that the direct aspiration first pass technique (ADAPT technique) for AIS obtains high recanalization rates, fast interventions and low costs when it works as first attempt. This study retrospectively describes revascularization efficacy, duration of procedure, intra and post-procedural complications, early and after 90-days clinical outcome in a group of patients who underwent ADAPT as the primary endovascular approach, eventually followed by stent retriever thrombectomy, for recanalization of large vessels in the anterior circulation.


METHODS
We analyzed clinical and procedural data of patients treated from April 2014 to August 2015. Recanalization was assessed according to the Thrombolysis in Cerebral Infarction score. Clinical outcome was evaluated at discharge and after 3 months (modified Rankin Scale, mRS).


RESULTS
Overall, 71 patients (mean age of 69.7 years) were treated. Sites of occlusion were anterior circulation (including seven tandem extracranial-intracranial occlusions). In 39 patients i.v. rtPA was attempted. Recanalization of the target vessel was obtained in 87.3% of cases whereas direct aspiration alone was successful in 46/71cases (64.8%) with an average puncture-to-revascularization time of 43.1 minutes. Symptomatic intracranial hemorrhage occurred in 7.8% and embolization to new territories in 5.6%. In total, 38 patients (53.5%) had a good outcome at 90 days follow-up.


CONCLUSIONS
In our series, the manual thromboaspiration technique has been shown as fast and safe, with good rates of vessel revascularization in 87.3% of patients and neurological outcome <3 mRS in 53.5% of patients.
Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy dromano80@gmail.com.
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Romano
Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
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Cioni
Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
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Leonini
Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
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Gennari
Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
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Vallone
Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
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Zandonella
Department of Human Pathology and Oncology, Section of Radiological Science, University of Siena, Siena, Italy.
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Puliti
Department of Neurological and Sensorineural Sciences, Stroke Unit, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
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Tassi
Unit of Endovascular and Percutaneous Therapy, Clinica Nuestra Senora del Rosario, Madrid, Spain.
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Casasco
Department of Neurological and Sensorineural Sciences, Stroke Unit, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
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Martini
Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
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Bracco
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery*; D013396:Suction; D016896:Treatment Outcome
Acute ischemic stroke; endovascular stroke treatment; thromboaspiration