Frontline ADAPT Therapy to Treat Patients with Symptomatic M2 and M3 Occlusions in Acute Ischemic Stroke: Initial Experience with the Penumbra ACE and 3MAX Reperfusion System

Overview

Journal J Neurointerv Surg

Publisher BMJ Publishing Group

Specialty Neurology

Date 2017 Aug 20

PMID 28821628

Citations 25

Authors

Jens Altenbernd

Oliver Kuhnt

Svenja Hennigs

Ruediger Hilker

Christian Loehr

Affiliations

Soon will be listed here.

Abstract

Background: After a series of positive studies for mechanical thrombectomy in large vessel occlusion acute ischemic stroke, the question remains, can symptomatic patients with distal vessel occlusion benefit from mechanical thrombectomy?

Purpose: To assess the safety and efficacy of the 3MAX reperfusion system as frontline therapy for M2 and M3 occlusions.

Methods: This study retrospectively collected data on 58 patients treated for M2 and M3 occlusions between January and September 2016. Of these 58 patients, 31 had an isolated M2 or M3 occlusion. Eligible patients were treated with 3MAX by adirect first pass aspiration (ADAPT) technique within 6 hours following stroke onset. Effectiveness was defined by functional independence (90-day modified Rankin Scale core 0-2) and revascularization to modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3 scores adjudicated by a core laboratory, while complication rates were used to determine safety of the device and the procedure.

Results: Patients with an isolated M2 or M3 occlusion had a mean age of 68.6±13.3 years (range 18-90 years), a median National Institutes of Health Stroke Score of 15 (IQR 9-19), and ASPECTS score of 9 (IQR 8-10). After intervention, 100% (31/31) of patients were revascularized to mTICI 2b-3; 77.4% (24/31) of patients showed revascularization to mTICI 3. Aspiration alone led to revascularization in 83.9% (26/31) of patients. At 90 days, 96.8% (30/31) of patients had achieved functional independence. The incidence of symptomatic intracranial hemorrhage was 0% (0/31).

Conclusions: Results suggest that the 3MAX reperfusion system is safe and effective in achieving successful revascularization and functional independence for patients with acute ischemic stroke secondary to M2 and M3 occlusions using ADAPT, either as frontline monotherapy, or in combination with adjunctive devices.

Citing Articles

Mechanical Thrombectomy for Middle Cerebral Artery Medium Vessel Occlusions Using Single Plane Angiography.

Amuluru K, Nguyen J, DeNardo A, Scott J, Gibson D, Al-Mufti F Clin Neuroradiol. 2025; .

PMID: 39966167 DOI: 10.1007/s00062-024-01492-2.

What You Always Wanted to Know about Endovascular Therapy in Acute Ischemic Stroke but Never Dared to Ask: A Comprehensive Review.

Bucke P, Cohen J, Horvath T, Cimpoca A, Bhogal P, Bazner H Rev Cardiovasc Med. 2024; 23(10):340.

PMID: 39077121 PMC: 11267361. DOI: 10.31083/j.rcm2310340.

Medium vessel occlusion thrombectomy: Single center experience using the 3 MAX catheter.

Ali A, Rao R, Sharkey B, Gega A, Oliver M, Chen T Interv Neuroradiol. 2024; :15910199241264328.

PMID: 39051591 PMC: 11569796. DOI: 10.1177/15910199241264328.

Multicenter evaluation of mechanical thrombectomy for distal medium vessel occlusions with National Institute of Health Stroke Scale Scores ≥ 6 and ≤ 6.

Kuhn A, Puri A, Salim H, Musmar B, Ghozy S, Siegler J J Neurol. 2024; 271(9):5853-5863.

PMID: 38967650 DOI: 10.1007/s00415-024-12537-4.

First-Line Aspiration Thrombectomy of M2 Occlusions with a Novel Reperfusion Catheter (REDTM 62): Real-World Experience from Two Tertiary Comprehensive Stroke Centers.

Grieb D, Wensing H, Schulz K, Loehr C, Lanfermann H, Schlunz-Hendann M Neurointervention. 2024; 19(3):139-147.

PMID: 38946131 PMC: 11540473. DOI: 10.5469/neuroint.2024.00171.

References

Navia P, Larrea J, Pardo E, Arce A, Martinez-Zabaleta M, Diez-Gonzalez N . Initial experience using the 3MAX cerebral reperfusion catheter in the endovascular treatment of acute ischemic stroke of distal arteries. J Neurointerv Surg. 2015; 8(8):787-90. DOI: 10.1136/neurintsurg-2015-011798. View

Turk A, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A . ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg. 2014; 6(4):260-4. DOI: 10.1136/neurintsurg-2014-011125. View

Turk A, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D . Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. 2013; 6(3):231-7. DOI: 10.1136/neurintsurg-2013-010713. View

Delgado Almandoz J, Kayan Y, Young M, Fease J, Scholz J, Milner A . Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg. 2015; 8(11):1123-1128. DOI: 10.1136/neurintsurg-2015-012122. View

Saver J, Goyal M, Bonafe A, Diener H, Levy E, Pereira V . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015; 372(24):2285-95. DOI: 10.1056/NEJMoa1415061. View

Campbell B, Mitchell P, Kleinig T, Dewey H, Churilov L, Yassi N . Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015; 372(11):1009-18. DOI: 10.1056/NEJMoa1414792. View

Sarraj A, Sangha N, Hussain M, Wisco D, Vora N, Elijovich L . Endovascular Therapy for Acute Ischemic Stroke With Occlusion of the Middle Cerebral Artery M2 Segment. JAMA Neurol. 2016; 73(11):1291-1296. DOI: 10.1001/jamaneurol.2016.2773. View

Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C . Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999; 282(21):2003-11. DOI: 10.1001/jama.282.21.2003. View

Haussen D, Lima A, Nogueira R . The Trevo XP 3×20 mm retriever ('Baby Trevo') for the treatment of distal intracranial occlusions. J Neurointerv Surg. 2015; 8(3):295-9. DOI: 10.1136/neurintsurg-2014-011613. View

10.

Berkhemer O, Fransen P, Beumer D, van den Berg L, Lingsma H, Yoo A . A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2014; 372(1):11-20. DOI: 10.1056/NEJMoa1411587. View

11.

Goyal M, Demchuk A, Menon B, Eesa M, Rempel J, Thornton J . Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015; 372(11):1019-30. DOI: 10.1056/NEJMoa1414905. View

12.

Jovin T, Chamorro A, Cobo E, de Miquel M, Molina C, Rovira A . Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015; 372(24):2296-306. DOI: 10.1056/NEJMoa1503780. View

13.

Kowoll A, Weber A, Mpotsaris A, Behme D, Weber W . Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center. J Neurointerv Surg. 2015; 8(3):230-4. DOI: 10.1136/neurintsurg-2014-011520. View

14.

. The Interventional Management of Stroke (IMS) II Study. Stroke. 2007; 38(7):2127-35. DOI: 10.1161/STROKEAHA.107.483131. View

15.

Tomsick T, Carrozzella J, Foster L, Hill M, von Kummer R, Goyal M . Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes. AJNR Am J Neuroradiol. 2016; 38(1):84-89. PMC: 7963682. DOI: 10.3174/ajnr.A4979. View

16.

. Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke. 2004; 35(4):904-11. DOI: 10.1161/01.STR.0000121641.77121.98. View

17.

Mpotsaris A, Bussmeyer M, Weber W . Mechanical thrombectomy with the penumbra 3D separator and lesional aspiration: technical feasibility and clinical outcome. Clin Neuroradiol. 2013; 24(3):245-50. DOI: 10.1007/s00062-013-0242-x. View

18.

Romano D, Cioni S, Vinci S, Pero G, Comelli C, Comai A . Thromboaspiration technique as first approach for endovascular treatment of acute ischemic stroke: initial experience at nine Italian stroke centers. J Neurointerv Surg. 2016; 9(1):6-10. DOI: 10.1136/neurintsurg-2016-012298. View