title: Intraprocedural Thrombus Fragmentation During Interventional Stroke Treatment: A Comparison of Direct Thrombus Aspiration and Stent Retriever Thrombectomy.
abstract: OBJECTIVE
  The aim of this study was to compare the rates of intraprocedural thrombus fragmentation between the exclusive thrombus aspiration technique (ADAPT) and the use of stent retrievers.
  
  
  METHODS
  Cases with successful recanalization of the primary occlusion site (POS) with either of the techniques were analyzed (n = 36 ADAPT, n = 61 stent retriever). The primary endpoint was the evaluation of intraprocedural thrombus fragmentation before applying additional maneuvers to enhance reperfusion success. Grading was performed using the modified thrombolysis in cerebral infarction (mTICI) perfusion scale grade with the implementation of an additional TICI 2c grade. Secondary endpoints were procedural complications and clinical data.
  
  
  RESULTS
  After opening of the POS, 83.3% successful reperfusions were reached using the ADAPT technique and 88.5% using stent retrievers (p = 0.47). Subarachnoid hemorrhages (SAH) appeared only when using stent retrievers (16.4 vs. 0%, p = 0.010). The number of maneuvers was significantly higher (median 2 vs. 1, p = 0.006), and procedural time was longer in the stent retriever group (median 30 vs. 13 min, p < 0.0001). There was no significant difference between both techniques with regard to the occurrence of embolizations to new territories (2.8 vs. 8.2%, p = 0.28).
  
  
  CONCLUSIONS
  When retrieving of the primary thrombus is possible, ADAPT results in comparable reperfusion grades as do stent retrievers. This suggests that comparable distraction forces act on the thrombus and that both techniques possess a comparable risk of periprocedural thrombus fragmentation. SAH exclusively occurred after using stent retrievers, which may further promote ADAPT as safe and fast initial front-line approach.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany. christian.maegerlein@tum.de.
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0003-4885-7671
authors.initials: C
authors.lastname: Maegerlein
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Prothmann
authors.affiliation: Department of Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Kristin Elizabeth
authors.initials: KE
authors.lastname: Lucia
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Friedrich
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kaesmacher
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000601:surgery*; D008297:Male; D015607:Stents; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*
keywords: ADAPT; Mechanical thrombectomy; Stent retriever; Stroke; Thrombus fragmentation