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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 306-310
DOI: 10.4103/ajns.AJNS_263_19
Original Article

Safety and efficacy of a direct aspiration first-pass technique with large-bore catheters for acute ischemic stroke in vietnam: Experience of a single center

Vu Luu
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Le Kien
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Tran Tuan
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Nguyen Anh
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Nguyen Thien
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Nguyen Trang
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Dao Phuong
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Mai Ton
1   Department of Emergency, Bach Mai Hospital, Hanoi
,
Pham Thong
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Le Cong
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Vu Trieu
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Nguyen Manh
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
,
Tran Cuong
Radiology Faculty, Bach Mai Radiology Center, Bach Mai Hospital, Hanoi Medical University, Hanoi
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Purpose: The purpose of this study was to evaluate the safety and efficacy of mechanical thrombectomy with a direct aspiration first-pass technique (ADAPT) using large-bore catheters in patients with acute ischemic stroke due to large vessel occlusion (LVO) in a hospital in Vietnam. Methods: This was a retrospective review of patients with acute ischemic stroke due to LVO who were diagnosed and underwent mechanical thrombectomy using ADAPT with large-bore catheters at Bach Mai Hospital from January 2017 to June 2018. Results: Seventy-three patients (47.9% female; age: 61.29 ± 14.49 years) met study criteria. The average procedure duration was 45.09 ± 38.26 min. Successful recanalization post-ADAPT (thrombolysis in cerebral infarction 2b-3) was achieved in 72.6% (53/73) of patients. Good functional outcome (Modified Rankin Scale 0–2) at 3 months was achieved in 50.7% (37/73), with poor functional outcome in 24.7% (18/73). The 90-day mortality rate was 24.7% (18/73). The hemorrhagic transformation rate was 31.6%, in which 19.2% were symptomatic. Vessel perforation occurred in 5.5% (4/73) of patients but in all cases was associated with the guidewire and not the reperfusion catheter. Vessel dissection occurred in 1.4% (1/73) and vasospasm in 5.5% (4/73) of patients. Conclusion: Mechanical thrombectomy using ADAPT with large-bore catheters for acute ischemic stroke due to LVO is a method that yielded good results in recanalization and clinical recovery in a Vietnamese patient population.

Key-words:

Acute ischemic stroke - Bach Mai Hospital - mechanical thrombectomy - thrombosis

Financial support and sponsorship

Nil.




Publication History

Received: 27 August 2019

Accepted: 27 January 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Katan M, Luft A. Global burden of stroke. Semin Neurol 2018;38:208-11.
  • 2 Naidech A. Hemorrhagic and Ischemic Stroke: Medical, Imaging, Surgical and Interventional Approaches. New York: Thieme; 2011.
  • 3 Schramm P, Navia P, Papa R, Zamarro J, Tomasello A, Weber W, et al. ADAPT technique with ACE68 and ACE64 reperfusion catheters in ischemic stroke treatment: Results from the PROMISE study. J Neurointerv Surg 2019;11:226-31.
  • 4 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.
  • 5 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.
  • 6 Zi W, Wang H, Yang D, Hao Y, Zhang M, Geng Y, et al. Clinical effectiveness and safety outcomes of endovascular treatment for acute anterior circulation ischemic stroke in China. Cerebrovasc Dis 2017;44:248-58.
  • 7 Li C, Zhao W, Wu C, Shang S, Chen J, Ren M, et al. Outcome of endovascular treatment for acute basilar artery occlusion in the modern era: A single institution experience. Neuroradiology 2018;60:651-9.
  • 8 Uno J, Kameda K, Otsuji R, Ren N, Nagaoka S, Maeda K, et al. A Direct AspirationFirst Pass Technique in Japanese real-world clinical setting. Oper Neurosurg (Hagerstown) 2019;17:115-22.
  • 9 Matsumoto H, Nishiyama H, Tetsuo Y, Takemoto H, Nakao N. Initial clinical experience using the two-stage aspiration technique (TSAT) with proximal flow arrest by a balloon guiding catheter for acute ischemic stroke of the anterior circulation. J Neurointerv Surg 2017;9:1160-5.
  • 10 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.
  • 11 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.
  • 12 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.
  • 13 Mocco J, Zaidat OO, von Kummer R, Yoo AJ, Gupta R, Lopes D, et al. Aspiration thrombectomy after intravenous alteplase versus intravenous alteplase alone. Stroke 2016;47:2331-8.
  • 14 Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11-20.
  • 15 Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. Mechanical thrombectomy for acute ischemic stroke: Final results of the multi MERCI trial. Stroke 2008;39:1205-12.
  • 16 Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: Safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 2009;40:2761-8.