Intraprocedural Thrombus Fragmentation During Interventional Stroke Treatment: A Comparison of Direct Thrombus Aspiration and Stent Retriever Thrombectomy.
PURPOSE
The aim of this study was to compare the rates of intraprocedural thrombus fragmentation between the exclusive thrombus aspiration technique (ADAPT) and the use of stent retrievers.


MATERIALS AND METHODS
Cases with successful recanalization of the primary occlusion site (POS) with either of the techniques were analyzed (n = 36 ADAPT, n = 61 stent retriever). The primary endpoint was the evaluation of intraprocedural thrombus fragmentation before applying additional maneuvers to enhance reperfusion success. Grading was performed using the modified thrombolysis in cerebral infarction (mTICI) perfusion scale grade with the implementation of an additional TICI 2c grade. Secondary endpoints were procedural complications and clinical data.


RESULTS
After opening of the POS, 83.3% successful reperfusions were reached using the ADAPT technique and 88.5% using stent retrievers (p = 0.47). Subarachnoid hemorrhages (SAH) appeared only when using stent retrievers (16.4 vs. 0%, p = 0.010). The number of maneuvers was significantly higher (median 2 vs. 1, p = 0.006), and procedural time was longer in the stent retriever group (median 30 vs. 13 min, p < 0.0001). There was no significant difference between both techniques with regard to the occurrence of embolizations to new territories (2.8 vs. 8.2%, p = 0.28).


CONCLUSION
When retrieving of the primary thrombus is possible, ADAPT results in comparable reperfusion grades as do stent retrievers. This suggests that comparable distraction forces act on the thrombus and that both techniques possess a comparable risk of periprocedural thrombus fragmentation. SAH exclusively occurred after using stent retrievers, which may further promote ADAPT as safe and fast initial front-line approach.
['Maegerlein|Christian|C|http://orcid.org/0000-0003-4885-7671', 'Prothmann|Sascha|S|', 'Lucia|Kristin Elizabeth|KE|', 'Zimmer|Claus|C|', 'Friedrich|Benjamin|B|', 'Kaesmacher|Johannes|J|']
D000368:Aged D003131:Combined Modality Therapy D057510:Endovascular Procedures D005260:Female D006801:Humans D020767:Intracranial Thrombosis D008297:Male D015607:Stents D020521:Stroke D017131:Thrombectomy
Thrombus fragmentation Stroke Stent retriever ADAPT Mechanical thrombectomy