Fast Stroke Treatment without Microcatheter and Wire

Zielsetzung:

Due to improved devices and techniques endovascular stroke treatment becomes faster year by year. The so-called ADAPT Technique can be fast and successful in many cases. For saving time and costs it is possible to do aspiration-catheter-only (ACO) navigation without additional microcatheter and wire. The main obstacle for success of the technique is the orifice of the ophthalmic artery (OAO). The aim of this analysis was to evaluate whether the preinterventional CTA scan allows an estimation of the possible success of this approach.

Material und Methoden:

We created a visual, easy to use score at sagittal CTA slices by determining the vertex of the cavernous ICA and defined 3 sectors (S1, S2, S3) where the OAO can be found. Four interventionalists tried 80 ACO approaches in 75 stroke cases with two different catheters. Approaches were rated as „easy“, „difficult“ or „not-possible“ and correlated with sectors.

Ergebnisse:

The OAO was located in S1 in 5 (6%), in S2 in 46 (58%) and in S3 in 29 (36%) cases. ACO approach was overall possible in 59% cases (S1 = 100%, S2 = 44%, S3 = 76%). The approaches were easy in 60% of S1, 24% of S2 and 66% of S3, and difficult in 40% of S1, 20% of S2 and 10% of S3. Overall the correlation between approaches and defined sectors were moderate (Pearson's Phi = 0.462, p = 0.002).

Schlussfolgerungen:

An OAO located in sector 1 or 3 seems to offer a good chance to reach the intracranial circulation with ACO. Our defined score may be helpful to decide whether to use additional microcatheter and wire for the first approach or not.