Objectives

A direct first-pass aspiration technique (ADAPT) is an attractive interventional technique for mechanical thrombectomy (MT), which could achieve recanalization quickly and safely at a small amount of material resources. To clarify its usefulness, our ADAPT first-line strategy for middle cerebral artery (MCA)-mainstem occlusion was retrospectively analyzed.

Materials and Methods

We reviewed 54 consecutive patients who underwent MT for MCA-mainstem occlusion using ADAPT first-line strategy. A salvage procedure was concurrently conducted in cases that failed to achieve successful recanalization by ADAPT attempt alone. Procedural and clinical outcome were assessed in both ADAPT alone and Salvage groups. Further investigation was performed in cases that required salvage procedure to determine the reason, risk factors, and optimal procedure.

Results

Forty-one patients (75.9%) were able to achieve successful recanalization with ADAPT technique alone. In salvage group, the procedural time was longer, and rates of successful recanalization were lower than in ADAPT-alone group. No significant difference in the rates of favorable outcomes was observed. Among 13 patients who required salvage therapy, the major reason (eight cases) was intra-procedural “thrombus distal migration”. Failure of recanalization was seen in two cases due to “inaccessibility”. In patients who had “thrombus distal migration”, occlusion in the proximal portion was more frequently observed than in patients who did not (p = 0.032, 63.6% vs. 23.3%).

Conclusions

Our ADAPT first-line strategy for MCA-mainstem occlusion demonstrated favorable procedural and clinical outcomes, even in cases that required additional procedures. Further investigation and better understanding are required to refine this promising procedure.

中文翻译：

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MCA 主干阻塞的 ADAPT 一线策略；最佳抢救治疗及其相关因素分析

目标

直接首过抽吸技术（ADAPT）是一种有吸引力的机械血栓切除术（MT）介入技术，可以以少量的物质资源快速安全地实现再通。为了阐明其实用性，我们回顾性分析了我们的大脑中动脉 (MCA) 主干闭塞的 ADAPT 一线策略。

材料和方法

我们使用 ADAPT 一线策略回顾了 54 名连续接受 MT 以进行 MCA 主干闭塞的患者。在仅通过 ADAPT 尝试未能成功再通的情况下，同时进行抢救程序。在单独的 ADAPT 和挽救组中评估了程序和临床结果。在需要抢救程序的情况下进行了进一步调查，以确定原因、风险因素和最佳程序。

结果

41 名患者 (75.9%) 能够单独使用 ADAPT 技术实现成功的再通。抢救组的手术时间较长，再通成功率低于单独 ADAPT 组。未观察到有利结果率的显着差异。在需要抢救治疗的 13 名患者中，主要原因（8 例）是术中“血栓远端迁移”。由于“无法接近”，在两种情况下出现了再通失败。在发生“血栓远端迁移”的患者中，近端部分的闭塞比没有发生的患者更频繁（p = 0.032，63.6% vs. 23.3%）。

结论

我们针对 MCA 主干闭塞的 ADAPT 一线策略显示出良好的程序和临床结果，即使在需要额外程序的情况下也是如此。需要进一步的调查和更好的理解来改进这个有希望的程序。