Stroke

The lack of difference in clinical outcomes between the two strategies may reflect the limited power of the study, researchers say.

A direct aspiration first pass technique—commonly called ADAPT—is associated with greater and faster recanalization than stent-retriever thrombectomy for basilar artery occlusions, according to a meta-analysis published online January 28, 2019, ahead of print in the Journal of NeuroInterventional Surgery. However, there was no difference between the two techniques with respect to clinical outcomes.

Several studies have explored the comparative efficacy of ADAPT versus stent-retriever thrombectomy for the treatment of anterior circulation stroke, senior author Daming Wang, MD (Beijing Hospital, China), told Neurovascular Exchange in an email. While most demonstrate comparable outcomes in terms of recanalization rates, neurological outcomes, and safety, most stent-retriever trials included use of large-bore catheters.

It therefore remains unclear whether the two strategies remain comparable for posterior circulation strokes, where large-bore catheters are more difficult to use, he explained.

Wang along with first author Gengfan Ye, MD (Beijing Hospital), and colleagues conducted a meta-analysis of five cohort studies (two prospective and three retrospective) totaling 476 cases that evaluated outcomes of thrombectomy for acute basal artery occlusions using first-line ADAPT (n = 193) or stent retrievers (n = 283).

The rate of successful recanalization was significantly higher and the incidence of a new territory embolic event significantly lower in the first-line ADAPT group. In addition, the procedure time was shorter with ADAPT, with a mean difference of 27.6 min. There was a trend toward more patients achieving complete recanalization (TICI 3) in the ADAPT cohort, but the difference was not statistically significant.

Outcomes by Treatment Approach: First-line ADAPT vs Stent-Retriever Thrombectomy

Additionally, no significant differences were seen between first-line ADAPT and stent-retriever thrombectomy with respect to rescue therapy, any hemorrhagic complication, favorable outcomes, or mortality at 90 days.

“Our studies suggested that, for patients with basilar artery occlusion, first-line ADAPT might achieve higher and faster recanalization while being relatively safe, compared with first-line [stent-retriever thrombectomy]”, noted Wang. “However, these effects did not translate into improvements in prognosis for these patients, which might be [due to the small] sample size.”

Given these findings, neurointerventionalists who are inclined to use stent-retriever thrombectomy should consider changing to ADAPT technique, especially in posterior circulation stroke, Wang suggested.

He noted, however, that the meta-analysis has its limitations, including the fact that it did not include any randomized controlled trials. In addition, he noted, “the total sample size limited the power of our results. [Also,] some important baseline characteristics were missing, such as stroke etiology and exact device used.”

Source:

Ye G, Lu J, Qi P, et al. Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion: a systematic review and meta-analysis. J NeuroInterv Surg. 2018;Epub ahead of print.

Disclosures:

Wang reports no relevant conflicts of interest.