Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke

Enrico Pampana, Sebastiano Fabiano, Gianluca De Rubeis, Luca Bertaccini, Alessandro Stasolla, Alberto Pingi, Valeria Cozzolino, Marilena Mangiardi, Sabrina Anticoli, Claudio Gasperini and Enrico Cotroneo
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Enrico Pampana: Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Sebastiano Fabiano: Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Gianluca De Rubeis: Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Luca Bertaccini: Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Alessandro Stasolla: Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Alberto Pingi: Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Valeria Cozzolino: Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Marilena Mangiardi: Emergency Department, UOSD, Stroke Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Sabrina Anticoli: Emergency Department, UOSD, Stroke Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Claudio Gasperini: Department of Neuroscience, UOC of Neurology, San Camillo-Forlanini Hospital, 00152 Rome, Italy
Enrico Cotroneo: Department of Diagnostic, UOC of Neuroradiology and Interventional Neuroradiology, San Camillo-Forlanini Hospital, 00152 Rome, Italy

IJERPH, 2021, vol. 18, issue 5, 1-8

Abstract: Background: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. Methods: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ? 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. Results: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ? 2a requiring switch to Solumbra. The vessel’s diameter positively predicted SS result (odd ratio (OR) 1.12, confidence of interval (CI) 95% 1.03–1.22; p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2–109.0) vs. 40.0 min (CI 95% 35.0–45.2); p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4–387.0) vs. 311.4 min (CI 95% 285.5–338.7); p = 0.23). Conclusion: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ? 2b was 92.6%). Vessel’s diameter positively predicted recourse to SS.

Keywords: stroke; cerebrovascular; thrombolysis; mechanical; thrombectomy; aspiration; outcome; treatment (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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