Mechanical Thrombectomy by Direct Aspiration First-Pass Technique in Ischemic Stroke: Initial Experience

Objectives: To study the therapeutic effectiveness of direct aspiration first-pass technique (ADAPT) in patients with large-vessel occlusion. Methods: From September 2017 to September 2019, a total of 25 patients presenting with large-vessel occlusion of anterior and posterior circulation underwent mechanical thrombectomy. In all the patients, we attempted clot aspiration with ADAPT. Ten patients also received intravenous tissue-type plasminogen activator. Every patient was initially evaluated with noncontrast computed tomography (CT) or magnetic resonance imaging (MRI) along with CT/MR angiography. If the patient presented beyond 6 h of clinical onset of symptoms, CT/MR perfusion was also done and was taken for mechanical thrombectomy according to the DEFUSE 3 trial criteria. Good clinical outcome was defined as an improvement of 8 points on NIHSS or NIHSS score 0 at discharge or modified Rankin scale ≤2 at discharge or at 90 days. Results: We obtained good revascularization (treatment in cerebral infarction IIb/III) in 20 out of 25 patients. Out of these 20 patients, in nine patients, we were able to get successful revascularization with this first-pass aspiration technique. No procedural complications were witnessed in these patients with ADAPT. Procedure-related subarachnoid hemorrhage happened in two patients, and in both, the patients' stent retrievers were being used. Conclusion: ADAPT is an effective endovascular method of stroke treatment with short procedural time. It is also cost-effective with less procedure-related complications.

Publication History

Article published online:
26 April 2021