CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 075-079
DOI: 10.1055/s-0043-1761233
Original Article

Initial Results of a Direct Aspiration First-Pass Technique to Treat Acute Ischemic Stroke Patients in Nepal

Subash Phuyal
1   Department of Neuroimaging and Interventional Neuroradiology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
2   Department of Neuroradiology, Grande International Hospital, Kathmandu, Nepal
Raju Paudel
3   Department of Neurology, Grande International Hospital, Kathmandu, Nepal
Ritesh Lamsal
4   Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
Lekhjung Thapa
5   Department of Neurology, National Neuro Centre, Kathmandu, Nepal
Anzil Mani Singh Maharjan
6   Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
Bikram Prasad Gajurel
7   Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
› Author Affiliations
Funding Penumbra, Inc. (Alameda, CA, USA) funded medical writing, editorial, and data analysis and preparation support.


Objective Endovascular therapy has become the mainstay of treatment of acute ischemic stroke (AIS) due to large vessel occlusion. A direct aspiration first-pass technique (ADAPT) using large bore aspiration catheters has been introduced as a rapid, simple method for achieving good revascularization and good clinical outcomes. The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to large-vessel occlusion in the Nepali patient population.

Materials and Methods Retrospective data were collected for all consecutive patients treated for AIS with ADAPT from March 2019 through January 2021 at two hospitals. Outcomes were successful revascularization (modified thrombolysis in cerebral infarction score of 2b-3), time to revascularization, procedural complications, and good clinical outcome (modified Rankin Scale score of 0 to 2) and mortality at 90 days.

Statistical Analysis Retrospective data were collected and descriptive statistics were calculated.

Results Sixty-eight patients treated for AIS with ADAPT were included. The median National Institutes of Health Stroke Scale score at presentation was 13 (IQR 10–13.25). The median time from arterial puncture to revascularization was 40 minutes (IQR 30–45). Successful revascularization was achieved in 54 patients (79.4%). No cases of symptomatic intracranial hemorrhage occurred. At 90-day follow-up, good clinical outcome was achieved in 57 patients (83.8%), and 4 patients died (5.9%).

Conclusion A direct aspiration first pass technique appears to be a fast, simple, safe, and effective method for the management of AIS in the Nepali patient population.

Ethical Approval

The manuscript conforms to the Declaration of Helsinki.

Publication History

Article published online:
27 March 2023

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