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Research ArticleINTERVENTIONAL

A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study

B. Lapergue, R. Blanc, P. Guedin, J.-P. Decroix, J. Labreuche, C. Preda, B. Bartolini, O. Coskun, H. Redjem, M. Mazighi, F. Bourdain, G. Rodesch and M. Piotin
American Journal of Neuroradiology October 2016, 37 (10) 1860-1865; DOI: https://doi.org/10.3174/ajnr.A4840
B. Lapergue
aFrom the Division of Neurology (B.L., J.-P.D., F.B.), Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
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R. Blanc
cDepartment of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France
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P. Guedin
bDepartment of Diagnostic and Interventional Neuroradiology (P.G., O.C., G.R.), Foch Hospital, Suresnes, France
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J.-P. Decroix
aFrom the Division of Neurology (B.L., J.-P.D., F.B.), Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
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J. Labreuche
dDepartment of Biostatistics (J.L.), Univiversity of Lille, Centre Hospitalier Universitaire Lille, Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
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C. Preda
eLaboratoire de Mathématiques Paul Painlevé (C.P.), Unité Mixte de Recherche CNRS 8524, Lille, France
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B. Bartolini
cDepartment of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France
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O. Coskun
bDepartment of Diagnostic and Interventional Neuroradiology (P.G., O.C., G.R.), Foch Hospital, Suresnes, France
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H. Redjem
cDepartment of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France
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M. Mazighi
fDepartment of Neurology and Stroke Center (M.M.), Lariboisière Hospital, Paris, France.
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F. Bourdain
aFrom the Division of Neurology (B.L., J.-P.D., F.B.), Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
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G. Rodesch
bDepartment of Diagnostic and Interventional Neuroradiology (P.G., O.C., G.R.), Foch Hospital, Suresnes, France
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M. Piotin
cDepartment of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France
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    FIGURE.

    Time from groin puncture to maximal revascularization after a front-line Solitaire stent retriever approach compared with ADAPT. P value for the comparison in time from groin puncture to maximal recanalization is reported (Mann-Whitney U test). Bars indicate the medians with interquartile range values, which were 50 minutes (range, 25–80 minutes) in the Solitaire group and 45 minutes (27–70 minutes) in the ADAPT group.

Tables

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    Table 1:

    Baseline characteristics in patients with acute ischemic stroke treated by ADAPT or a conventional stent retriever front-line approacha

    Solitaire Group (n = 119)ADAPT Group (n = 124)P Value
    Age (yr) (mean)65.5 ± 14.764.3 ± 15.7.52
    Men55 (46.2)61 (49.1).64
    Medical history
        Hypertension56 (47.5)72 (59.0).073
        Diabetes7 (5.9)21 (17.2).007
        Hypercholesterolemia31 (26.3)32 (26.2).99
        Current smoking20 (18.4)27 (22.1).48
        Antithrombotic therapy43 (36.1)44 (35.8).95
        NIHSS score (mean)15.9 ± 6.115.9 ± 6.5.99
        ASPECTS value at admission (median) (IQR)8 (7–10)9 (8–10).64
    Occlusion site
        ICA (isolated or tandem with MCA)32 (26.9)38 (30.7).52
        Isolated MCA87 (73.1)86 (69.3)
    Previous use of IV thrombolysis54 (45.4)82 (66.1).001
    Onset-to-groin puncture time (min) (median) (IQR)235 (181–300)247 (206–308).18
    • Note:—IQR indicates interquartile range.

    • ↵a Values are expressed as number (percentages) unless otherwise indicated.

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    Table 2:

    Outcomes in ADAPT or Solitaire group

    OutcomesaSolitaire Group (n = 119)ADAPT Group (n= 124)Relative RiskP ValueRelative RiskbP Valueb
    Successful revascularization at final angiogram82 (68.9)102 (82.3)1.19 (1.03–1.38).0151.18 (1.02–1.37).022
    Early neurologic improvement61 (55.5)56 (57.1)1.03 (0.81–1.31).811.00 (0.78–1.28).99
    90-day excellent outcome44 (38.3)45 (39.1)1.02 (0.73–1.42).891.10 (0.78–1.56).58
    90-day favorable outcome63 (54.8)61 (53.0)0.97 (0.76–1.23).791.05 (0.82–1.35).70
    90-day mortality20 (17.4)26 (22.6)1.30 (0.77–2.19).321.14 (0.64–2.01).65
    ENT8 (6.8)7 (5.7)–.70––
    sICH7 (5.9)3 (2.4)–.21––
    • Note:—ENT indicates embolization in a new territory rate; sICH, symptomatic intracranial hemorrhage.

    • ↵a Early neurologic improvement is defined as an NIHSS score 0–1 at 24 hours or a decrease of ≥4 points in NIHSS scores at 24 hours. Excellent outcome is defined as an mRS score of ≤1; favorable outcome, an mRS score of ≤2; and successful recanalization, an mTICI score of 2b–3 at final angiography.

    • ↵b Adjusted for between-group differences in hypertension, diabetes, prior IV thrombolysis, and onset-to-groin puncture time (calculated with a robust Poisson regression model).

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American Journal of Neuroradiology: 37 (10)
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B. Lapergue, R. Blanc, P. Guedin, J.-P. Decroix, J. Labreuche, C. Preda, B. Bartolini, O. Coskun, H. Redjem, M. Mazighi, F. Bourdain, G. Rodesch, M. Piotin
A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study
American Journal of Neuroradiology Oct 2016, 37 (10) 1860-1865; DOI: 10.3174/ajnr.A4840

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A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study
B. Lapergue, R. Blanc, P. Guedin, J.-P. Decroix, J. Labreuche, C. Preda, B. Bartolini, O. Coskun, H. Redjem, M. Mazighi, F. Bourdain, G. Rodesch, M. Piotin
American Journal of Neuroradiology Oct 2016, 37 (10) 1860-1865; DOI: 10.3174/ajnr.A4840
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