Introduction: Treatment options for acute ischemic stroke have rapidly evolved. Development of new revascularization devices has led to faster recanalization rates and better outcomes. The ADAPT technique is a simple and fast method for achieving good angiographic and clinical outcomes using large bore aspiration catheters. We present our results in the use of the technique with distal anterior circulation occlusions.
Methods: Retrospective analysis from a prospectively maintained database was gathered on patients undergoing thrombectomy with ADAPT technique for lesions in distal MCA and ACA at the Medical University of South Carolina. Parameters captured included age, gender, NIHSS score at presentation, time to presentation from last normal, and modi?ed Rankin Scale score at 90-days. Radiological and angiographic imaging was reviewed to document location of vascular occlusion, TICI ?ow post procedure, and procedural complications.
Results: 36 patients with thrombus in distal middle cerebral or anterior cerebral arteries were treated. 20 were female. Average age was 65 years. Patients presented with mean NIHSS score of 13.8. 15 received IV tPA. Average time from onset to puncture was 7.41 hours. 30 patients (83.33%) presented with M2 occlusion, and one presented with an A3 occlusion (2.78%). Two (5.56%) had basilar occlusions with additional lesions in left M2 divisions. One patient had a left ICA occlusion with tandem lesions in left M2 and A2, another had a right ICA occlusion with tandem lesion in right M2. One had a left M1 occlusion with tandem lesion in ipsilateral M3. Average time to recanalization was 33.58 minutes. TICI 2B or better was achieved in 35 patients (97.2%). 8 (22.22%) required adjunctive techniques. 90-day mRS was available in 33 patients, and averaged 1.97. 60.6% of patients had an mRS of 0-2 at 90 days. No patients died.
Conclusions: The ADAPT technique is a safe and effective tool for distal anterior circulation ischemic strokes.
Patient Care: This study demonstrates the safety and efficacy of the ADAPT technique in the management of acute ischemic stroke.
Learning Objectives: The audience should be able to understand the role of the ADAPT technique in the treatment of acute ischemic stroke in a timely manner.