Progressnotes - October/November 2012
- About MUSC Health
For patients with severe ischemic stroke, thrombectomy may offer the best hope of minimizing stroke-related morbidity. Endovascular neurosurgeons Raymond D. Turner, M.D., and Alejandro M. Spiotta, M.D., and neurointerventional radiologists Aquilla S. Turk, D.O., and M. Imran Chaudry, M.D., are pioneering the ADAPT technique, a direct-aspiration, first-pass technique for stroke thrombectomy using a large-bore catheter.
A guide catheter is positioned as far distally as possible to the thrombus, providing stable support for a reperfusion catheter that is then advanced into the thrombus. Aspiration is applied to the reperfusion catheter to engage the clot and maintain it at the tip of the catheter to allow for removal. In a retrospective study led by MUSC physicians of 37 cases at six centers, the ADAPT technique was successful in retrieving the thrombus in 28 (75%), six of which required additional aspiration for removal of downstream emboli (Turk AS, et al. J NeuroIntervent Surg. Published Online First 2013 Apr 27). National Institutes of Health Stroke Scale scores improved from a mean of 16.3 on admission to 4.2 at discharge.
The rapid neurological improvements are likely attributable to the speed and quality of recanalization with the ADAPT technique (faster than in any previously reported thrombectomy series). Unlike stent retrievers or separators that break up the clot for removal, the ADAPT technique attempts to remove the clot in its entirety; if fragmentation occurs, pieces are usually large enough to allow for mechanical retrieval. At the twelfth congress of the World Federation of Interventional and Therapeutic Neuroradiology (Buenos Aires, Argentina; November 9-13, 2013), the team presented a prospective study of 84 cases at those same six centers, with even more impressive results and at a significantly lower direct cost to the institution.