Different learning curves between stent retrieval and a direct aspiration first-pass technique for acute ischemic stroke

Hidehisa Nishi, Akira Ishii, Ichiro Nakahara, Shoji Matsumoto, Nobutake Sadamasa, Yasutoshi Kai, Ryota Ishibashi, Michio Yamamoto, Satoshi Morita, Izumi Nagata

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVEThe clinical outcomes of a direct aspiration first-pass technique (ADAPT) and stent retriever (SR) have been reported to be similar in several observational studies. In this study, procedural and clinical outcomes with ADAPT and SR for the treatment of acute ischemic stroke with large artery occlusion were compared in different time periods.METHODSIn each specific time period, SR and ADAPT were used as the first-line treatment approach for acute ischemic stroke patients with large artery occlusion at the authors' institution. Baseline characteristics, procedural variables, and functional outcome at 90 days were compared between patients treated with SR and those treated with ADAPT. These 2 groups were divided into 3 sequential subgroups to assess the learning curve effects of the endovascular team and individual operators on the procedural variables of each treatment strategy.RESULTSOverall, 89 patients were treated. In the SR group, the recanalization rate was higher (84% vs 65%; p = 0.01) and the procedure time was shorter than in the ADAPT group (median 42 minutes vs 76 minutes, p = 0.04). On the subgroup analysis of the learning curve, the SR group showed more rapid improvement in procedure time than the ADAPT group (p = 0.01 for the team; p < 0.01 for individual operators).CONCLUSIONSIn this initial experience, a higher recanalization rate and shorter procedure time were achieved with SR than with ADAPT. A high recanalization rate with SR was possible with relatively less clinical experience, whereas procedure time dramatically decreased with experience. These observed effects on the learning curve might be useful when choosing the method for initial endovascular treatment of acute ischemic stroke at relatively small stroke centers.

Original languageEnglish
Pages (from-to)1456-1463
Number of pages8
JournalJournal of neurosurgery
Volume129
Issue number6
DOIs
Publication statusPublished - Dec 1 2018
Externally publishedYes

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Learning Curve
Stents
Stroke
Arteries
Aspirations (Psychology)
Therapeutics
Observational Studies

Keywords

  • acute ischemic stroke
  • ADAPT
  • ADAPT = a direct aspiration first-pass technique
  • ICA = internal carotid artery
  • IQR = interquartile range
  • learning curve
  • mRS = modified Rankin Scale
  • mTICI = modified Thrombolysis in Cerebral Infarction
  • NIHSS = National Institutes of Health Stroke Scale
  • SICH = symptomatic intracerebral hemorrhage
  • SR = stent retriever
  • stent retriever
  • vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Different learning curves between stent retrieval and a direct aspiration first-pass technique for acute ischemic stroke. / Nishi, Hidehisa; Ishii, Akira; Nakahara, Ichiro; Matsumoto, Shoji; Sadamasa, Nobutake; Kai, Yasutoshi; Ishibashi, Ryota; Yamamoto, Michio; Morita, Satoshi; Nagata, Izumi.

In: Journal of neurosurgery, Vol. 129, No. 6, 01.12.2018, p. 1456-1463.

Research output: Contribution to journalArticle

Nishi, H, Ishii, A, Nakahara, I, Matsumoto, S, Sadamasa, N, Kai, Y, Ishibashi, R, Yamamoto, M, Morita, S & Nagata, I 2018, 'Different learning curves between stent retrieval and a direct aspiration first-pass technique for acute ischemic stroke', Journal of neurosurgery, vol. 129, no. 6, pp. 1456-1463. https://doi.org/10.3171/2017.6.JNS17872
Nishi, Hidehisa ; Ishii, Akira ; Nakahara, Ichiro ; Matsumoto, Shoji ; Sadamasa, Nobutake ; Kai, Yasutoshi ; Ishibashi, Ryota ; Yamamoto, Michio ; Morita, Satoshi ; Nagata, Izumi. / Different learning curves between stent retrieval and a direct aspiration first-pass technique for acute ischemic stroke. In: Journal of neurosurgery. 2018 ; Vol. 129, No. 6. pp. 1456-1463.
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abstract = "OBJECTIVEThe clinical outcomes of a direct aspiration first-pass technique (ADAPT) and stent retriever (SR) have been reported to be similar in several observational studies. In this study, procedural and clinical outcomes with ADAPT and SR for the treatment of acute ischemic stroke with large artery occlusion were compared in different time periods.METHODSIn each specific time period, SR and ADAPT were used as the first-line treatment approach for acute ischemic stroke patients with large artery occlusion at the authors' institution. Baseline characteristics, procedural variables, and functional outcome at 90 days were compared between patients treated with SR and those treated with ADAPT. These 2 groups were divided into 3 sequential subgroups to assess the learning curve effects of the endovascular team and individual operators on the procedural variables of each treatment strategy.RESULTSOverall, 89 patients were treated. In the SR group, the recanalization rate was higher (84{\%} vs 65{\%}; p = 0.01) and the procedure time was shorter than in the ADAPT group (median 42 minutes vs 76 minutes, p = 0.04). On the subgroup analysis of the learning curve, the SR group showed more rapid improvement in procedure time than the ADAPT group (p = 0.01 for the team; p < 0.01 for individual operators).CONCLUSIONSIn this initial experience, a higher recanalization rate and shorter procedure time were achieved with SR than with ADAPT. A high recanalization rate with SR was possible with relatively less clinical experience, whereas procedure time dramatically decreased with experience. These observed effects on the learning curve might be useful when choosing the method for initial endovascular treatment of acute ischemic stroke at relatively small stroke centers.",
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T1 - Different learning curves between stent retrieval and a direct aspiration first-pass technique for acute ischemic stroke

AU - Nishi, Hidehisa

AU - Ishii, Akira

AU - Nakahara, Ichiro

AU - Matsumoto, Shoji

AU - Sadamasa, Nobutake

AU - Kai, Yasutoshi

AU - Ishibashi, Ryota

AU - Yamamoto, Michio

AU - Morita, Satoshi

AU - Nagata, Izumi

PY - 2018/12/1

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N2 - OBJECTIVEThe clinical outcomes of a direct aspiration first-pass technique (ADAPT) and stent retriever (SR) have been reported to be similar in several observational studies. In this study, procedural and clinical outcomes with ADAPT and SR for the treatment of acute ischemic stroke with large artery occlusion were compared in different time periods.METHODSIn each specific time period, SR and ADAPT were used as the first-line treatment approach for acute ischemic stroke patients with large artery occlusion at the authors' institution. Baseline characteristics, procedural variables, and functional outcome at 90 days were compared between patients treated with SR and those treated with ADAPT. These 2 groups were divided into 3 sequential subgroups to assess the learning curve effects of the endovascular team and individual operators on the procedural variables of each treatment strategy.RESULTSOverall, 89 patients were treated. In the SR group, the recanalization rate was higher (84% vs 65%; p = 0.01) and the procedure time was shorter than in the ADAPT group (median 42 minutes vs 76 minutes, p = 0.04). On the subgroup analysis of the learning curve, the SR group showed more rapid improvement in procedure time than the ADAPT group (p = 0.01 for the team; p < 0.01 for individual operators).CONCLUSIONSIn this initial experience, a higher recanalization rate and shorter procedure time were achieved with SR than with ADAPT. A high recanalization rate with SR was possible with relatively less clinical experience, whereas procedure time dramatically decreased with experience. These observed effects on the learning curve might be useful when choosing the method for initial endovascular treatment of acute ischemic stroke at relatively small stroke centers.

AB - OBJECTIVEThe clinical outcomes of a direct aspiration first-pass technique (ADAPT) and stent retriever (SR) have been reported to be similar in several observational studies. In this study, procedural and clinical outcomes with ADAPT and SR for the treatment of acute ischemic stroke with large artery occlusion were compared in different time periods.METHODSIn each specific time period, SR and ADAPT were used as the first-line treatment approach for acute ischemic stroke patients with large artery occlusion at the authors' institution. Baseline characteristics, procedural variables, and functional outcome at 90 days were compared between patients treated with SR and those treated with ADAPT. These 2 groups were divided into 3 sequential subgroups to assess the learning curve effects of the endovascular team and individual operators on the procedural variables of each treatment strategy.RESULTSOverall, 89 patients were treated. In the SR group, the recanalization rate was higher (84% vs 65%; p = 0.01) and the procedure time was shorter than in the ADAPT group (median 42 minutes vs 76 minutes, p = 0.04). On the subgroup analysis of the learning curve, the SR group showed more rapid improvement in procedure time than the ADAPT group (p = 0.01 for the team; p < 0.01 for individual operators).CONCLUSIONSIn this initial experience, a higher recanalization rate and shorter procedure time were achieved with SR than with ADAPT. A high recanalization rate with SR was possible with relatively less clinical experience, whereas procedure time dramatically decreased with experience. These observed effects on the learning curve might be useful when choosing the method for initial endovascular treatment of acute ischemic stroke at relatively small stroke centers.

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KW - NIHSS = National Institutes of Health Stroke Scale

KW - SICH = symptomatic intracerebral hemorrhage

KW - SR = stent retriever

KW - stent retriever

KW - vascular disorders

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