Mechanical Thrombectomy by a Direct Aspiration First Pass Technique (ADAPT) in Ischemic Stroke: Results of Monocentric Study Based on Multimodal CT Patient Selection

INTRODUCTION: Mechanical thrombectomy with ADAP-technique of ischemic stroke has been reported as fast and effective. Aim of this study is to evaluate imaging criteria as possible predictors of stroke severity, therapeutic success, and outcome. MATERIALS AND METHODS: Patients (30) presenting from October 2015 to April 2017 with Emergent Large Vessel Occlusion of the anterior circulation were treated with ADAP-technique. 22 received also IV tPA; 8 underwent endovascular treatment only. Every patient was evaluated with noncontrast CT, multiphase angiography-CT, and perfusion CT. Clinical and radiological characteristics were measured. Good clinical outcome was an improvement of 8 points on NIHSS at discharge or a modified Rankin Scale ≤2 at discharge and at 90 days. RESULTS: Successful revascularization was obtained in 57% of patients, no procedural complications were witnessed, and only two hemorrhages were reported. Good outcome at discharge was obtained in 11 patients (37%) and predicted by NCCT ASPECT and TICI; outcome at 90 days was predicted by NCCT ASPECT, clot length, and premorbid mRS. Mortality was 23% at discharge and 30% at 90 days. CONCLUSION: ADAPT is an effective endovascular method of stroke treatment with fast procedural times. Multimodal CT evaluation is effective in assessing stroke severity, providing important prognostic information, which is able to select patients for the appropriate treatment.