Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world
Abstract Background Embolectomy is the standard of care in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Aim of this study was to compare two techniques: A Direct Aspiration First Pass Technique (ADAPT) and Stent-retriever Assisted Vacuum-locked Extraction (SAVE) stratified by...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Neurology |
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| Online Access: | http://link.springer.com/article/10.1186/s12883-019-1291-9 |
| _version_ | 1811205240365514752 |
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| author | Alex Brehm Volker Maus Ioannis Tsogkas Ruben Colla Amélie Carolina Hesse Roland Gerard Gera Marios-Nikos Psychogios |
| author_facet | Alex Brehm Volker Maus Ioannis Tsogkas Ruben Colla Amélie Carolina Hesse Roland Gerard Gera Marios-Nikos Psychogios |
| author_sort | Alex Brehm |
| collection | DOAJ |
| description | Abstract Background Embolectomy is the standard of care in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Aim of this study was to compare two techniques: A Direct Aspiration First Pass Technique (ADAPT) and Stent-retriever Assisted Vacuum-locked Extraction (SAVE) stratified by the occluded vessel. Methods One hundred seventy-one patients (71 male) treated between January 2014 and September 2017 with AIS due to LVO of the anterior circulation (55 carotid T, 94 M1, 22 M2) were included. Treatment techniques were divided into two categories: ADAPT and SAVE. Primary endpoints were successful reperfusion (mTICI ≥2b), near-perfect reperfusion (mTICI ≥2c) and groin puncture to reperfusion time. Secondary endpoints were the number of device-passes, first-pass reperfusion, the frequency of emboli to new territory (ENT), clinical outcome at 90 days, and the frequency of symptomatic intracranial hemorrhage (sICH). Analysis was performed on an intention to treat basis. Results Overall, SAVE resulted in significant higher rates of successful reperfusion (mTICI≥2b) compared to ADAPT (93.5% vs 75.0%; p = 0.006). After stratification for the occluded vessel only the carotid T remained significant with higher rates of near-perfect reperfusion (mTICI≥2c) (55.2% vs 15.4%; p = 0.025), while for successful reperfusion a trend remained (93.1% vs 65.4%; p = 0.10). Groin to reperfusion times were not significantly different. Secondary analysis revealed higher rates of first-pass successful reperfusion (59.6% vs 33.3%; p = 0.019), higher rates of first-pass near-perfect reperfusion in the carotid T (35.4% vs 16.7%; p = 0.038) and a lower number of device-passes overall (median 1 IQR 1–2 vs 2 IQR 2–3; p < 0.001) and in the carotid T (median 2 IQR 1.3 vs 3 IQR 2–5; p < 0.001) for SAVE. Clinical outcome and safety parameters were comparable between groups. Conclusions Embolectomy using SAVE appears superior to ADAPT, especially for carotid T occlusions with regard to reperfusion success. |
| first_indexed | 2024-04-12T03:27:23Z |
| format | Article |
| id | doaj.art-973252c1229c466d874a29b652adcf17 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-12T03:27:23Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-973252c1229c466d874a29b652adcf172022-12-22T03:49:39ZengBMCBMC Neurology1471-23772019-04-011911810.1186/s12883-019-1291-9Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-worldAlex Brehm0Volker Maus1Ioannis Tsogkas2Ruben Colla3Amélie Carolina Hesse4Roland Gerard Gera5Marios-Nikos Psychogios6Department of Neuroradiology, University Medical Center GoettingenDepartment of Neuroradiology, University Medical Center GoettingenDepartment of Neuroradiology, University Medical Center GoettingenDepartment of Neuroradiology, University Medical Center GoettingenDepartment of Neuroradiology, University Medical Center GoettingenDepartment of Medical Statistics, University Medical Center GoettingenDepartment of Neuroradiology, University Medical Center GoettingenAbstract Background Embolectomy is the standard of care in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Aim of this study was to compare two techniques: A Direct Aspiration First Pass Technique (ADAPT) and Stent-retriever Assisted Vacuum-locked Extraction (SAVE) stratified by the occluded vessel. Methods One hundred seventy-one patients (71 male) treated between January 2014 and September 2017 with AIS due to LVO of the anterior circulation (55 carotid T, 94 M1, 22 M2) were included. Treatment techniques were divided into two categories: ADAPT and SAVE. Primary endpoints were successful reperfusion (mTICI ≥2b), near-perfect reperfusion (mTICI ≥2c) and groin puncture to reperfusion time. Secondary endpoints were the number of device-passes, first-pass reperfusion, the frequency of emboli to new territory (ENT), clinical outcome at 90 days, and the frequency of symptomatic intracranial hemorrhage (sICH). Analysis was performed on an intention to treat basis. Results Overall, SAVE resulted in significant higher rates of successful reperfusion (mTICI≥2b) compared to ADAPT (93.5% vs 75.0%; p = 0.006). After stratification for the occluded vessel only the carotid T remained significant with higher rates of near-perfect reperfusion (mTICI≥2c) (55.2% vs 15.4%; p = 0.025), while for successful reperfusion a trend remained (93.1% vs 65.4%; p = 0.10). Groin to reperfusion times were not significantly different. Secondary analysis revealed higher rates of first-pass successful reperfusion (59.6% vs 33.3%; p = 0.019), higher rates of first-pass near-perfect reperfusion in the carotid T (35.4% vs 16.7%; p = 0.038) and a lower number of device-passes overall (median 1 IQR 1–2 vs 2 IQR 2–3; p < 0.001) and in the carotid T (median 2 IQR 1.3 vs 3 IQR 2–5; p < 0.001) for SAVE. Clinical outcome and safety parameters were comparable between groups. Conclusions Embolectomy using SAVE appears superior to ADAPT, especially for carotid T occlusions with regard to reperfusion success.http://link.springer.com/article/10.1186/s12883-019-1291-9Acute ischemic strokeThrombectomyLarge vessel occlusionTechnique |
| spellingShingle | Alex Brehm Volker Maus Ioannis Tsogkas Ruben Colla Amélie Carolina Hesse Roland Gerard Gera Marios-Nikos Psychogios Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world BMC Neurology Acute ischemic stroke Thrombectomy Large vessel occlusion Technique |
| title | Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world |
| title_full | Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world |
| title_fullStr | Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world |
| title_full_unstemmed | Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world |
| title_short | Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world |
| title_sort | stent retriever assisted vacuum locked extraction save versus a direct aspiration first pass technique adapt for acute stroke data from the real world |
| topic | Acute ischemic stroke Thrombectomy Large vessel occlusion Technique |
| url | http://link.springer.com/article/10.1186/s12883-019-1291-9 |
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