Initial results of management for acute ischemic stroke due to large vessel occlusion by a direct aspiration first pass technique at a Vietnamese hospital

Background: The development of novel revascularization devices has improved procedural and clinical outcomes in acute ischemic stroke (AIS). A direct aspiration first pass technique (ADAPT) has been introduced as a rapid simple method for achieving good recanalization and clinical outcomes using large bore aspiration catheters in the treatment of AIS due to large vessel occlusion (LVO). Objectives: The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to LVO in the Vietnamese patient population. Materials and Methods: A retrospective analysis of a hospital database was conducted on all patients undergoing stroke therapy with the ADAPT technique at the institution from January 2017 to December 2017. Efficacy and safety were evaluated by the variables: revascularization rates (thrombolysis in cerebral infarction [TICI] score), time to revascularization, procedural complications, and clinical outcomes (modified Rankin scale [mRS] score) at the 90-day follow-up visit. Results: From the database review, 37 AIS patients treated with ADAPT were identified. The mean NIHSS score at presentation was 17.3 and improved to 8.9 at discharged. The average time arterial puncture to revascularization was 32.5 min. TICI 2b/3 revascularization was achieved in 30/37 (81.1%) patients, good clinical outcomes were achieved (mRS 0–2) in 21/37 (56.7%) patients, and mortality rate was 6/37 (16.2%) during follow-up. Conclusions: ADAPT utilizing large bore aspiration catheters appears to be a fast, simple, safe, and effective method for the management of AIS in the Vietnamese patient population.

Key-words:

A direct aspiration first pass technique - endovascular management - large vessel occlusion

Financial support and sponsorship

Nil.

Publication History

Received: 16 August 2019

Accepted: 14 October 2019

Article published online:
16 August 2022

• References

• 1 Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation 2018;137:e67-492.
• 2 World Health Organization. Mortality and Global Health Estimates. Geneva. Available from: http://www.who.int/gho/mortality_burden_disease/en/. [Last accessed on 2018 Sep 10].
• 3 Yamanashi H, Ngoc MQ, Huy TV, Suzuki M, Tsujino A, Toizumi M, et al. Population-based incidence rates of first-ever stroke in central Vietnam. PLoS One 2016;11:e0160665.
• 4 Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. Arandomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11-20.
• 5 Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019-30.
• 6 Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009-18.
• 7 Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285-95.
• 8 Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296-306.
• 9 Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): A randomised controlled trial. Lancet Neurol 2016;15:1138-47.
• 10 Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: A Guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:3020-35.
• 11 Wahlgren N, Moreira T, Michel P, Steiner T, Jansen O, Cognard C, et al. Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int J Stroke 2016;11:134-47.
• 12 Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: A Guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49:e46-110.
• 13 Turk AS, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A, et al. ADAPT FAST study: A direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg 2014;6:260-4.
• 14 Kowoll A, Weber A, Mpotsaris A, Behme D, Weber W. Direct aspiration first pass technique for the treatment of acute ischemic stroke: Initial experience at a European stroke center. J Neurointerv Surg 2016;8:230-4.
• 15 Gory B, Armoiry X, Sivan-Hoffmann R, Piotin M, Mazighi M, Lapergue B, et al. Adirect aspiration first pass technique for acute stroke therapy: A systematic review and meta-analysis. Eur J Neurol 2018;25:284-92.
• 16 Vargas J, Spiotta A, Fargen K, Turner R, Chaudry I, Turk A, et al. Long term experience using the ADAPT technique for the treatment of acute ischemic stroke. J Neurointerv Surg 2017;9:437-41.
• 17 Hesse AC, Behme D, Kemmling A, Zapf A, Große Hokamp N, Frischmuth I, et al. Comparing different thrombectomy techniques in five large-volume centers: A 'real world' observational study. J Neurointerv Surg 2018;10:525-9.
• 18 Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, et al. Effect of endovascular contact aspiration vs. stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: The ASTER randomized clinical trial. JAMA 2017;318:443-52.
• 19 Nogueira RG, Frei D, Kirmani JF, Zaidat O, Lopes D, Turk AS 3rd, et al. Safety and efficacy of a 3-dimensional stent retriever with aspiration-based thrombectomy vs. aspiration-based thrombectomy alone in acute ischemic stroke intervention: A randomized clinical trial. JAMA Neurol 2018;75:304-11.
• 20 Turk AS 3rd, Siddiqui A, Fifi JT, De Leacy RA, Fiorella DJ, Gu E, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): A multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet 2019;393:998-1008.
• 21 Koo J. The latest information on intracranial atherosclerosis: Diagnosis and treatment. Interv Neurol 2015;4:48-50.
• 22 Ng JC, Churojana A, Pongpech S, Vu LD, Sadikin C, Mahadevan J, et al. Current state of acute stroke care in Southeast Asian countries. Interv Neuroradiol 2019;25:291-6.
• 23 Alawieh A, Vargas J, Turner RD, Turk AS, Chaudry MI, Lena J, et al. Equivalent favorable outcomes possible after thrombectomy for posterior circulation large vessel occlusion compared with the anterior circulation: The MUSC experience. J Neurointerv Surg 2018;10:735-40.
• 24 Turk AS, Turner R, Spiotta A, Vargas J, Holmstedt C, Ozark S, et al. Comparison of endovascular treatment approaches for acute ischemic stroke: Cost effectiveness, technical success, and clinical outcomes. J Neurointerv Surg 2015;7:666-70.
• 25 Takashima K, Wada K, Tra TT, Smith DR. A review of Vietnam's healthcare reform through the direction of healthcare activities (DOHA). Environ Health Prev Med 2017;22:74.
• 26 Hoang CK, Hill P, Nguyen HT. Universal health insurance coverage in Vietnam: A Stakeholder analysis from policy proposal (1989) to implementation (2014). J Public Health Manag Pract 2018;24 Suppl 2:S52-9.
• 27 Saver JL. Time is brain – Quantified. Stroke 2006;37:263-6.