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Interest of Direct Aspiration First Pass Technique (ADAPT) for Thrombectomy Revascularisation of Large Vessel Occlusion in Acute Ischaemic Stroke (ASTER)

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ClinicalTrials.gov Identifier: NCT02523261
Recruitment Status : Completed
First Posted : August 14, 2015
Last Update Posted : February 8, 2018
Sponsor:
Information provided by (Responsible Party):
Fondation Ophtalmologique Adolphe de Rothschild

Brief Summary:

Mechanical thrombectomy (TM) is now validated through 4 randomized controlled trials of high scientific level as the reference treatment of cerebral infarction associated with proximal cerebral occlusion (MR CLEAN, ESCAPE 2014, 2015). These studies have shown for the first time a major decrease (-35%) of disability related to severe cerebral infarction and reduction in mortality. These studies only used thrombectomy devices called stent retriever for obtaining recanalization rates ranging from 58-72% for the 2 largest studies (MR CLEAN, ESCAPE 2014, 2015). This criterion "recanalization" is important because it largely determines the functional prognosis of patients with severe cerebral infarction (Khatri, 2014).

These results are exciting but we can do even better. Indeed, already new thrombectomy devices are available with a special interest for ADAPT (A Direct Aspiration First Pass Technic). This distal suction system, with a high level of endovascular navigability, provides high recanalization rates (> 90%), low morbidity, with a synergistic effect with stent retriever (Turk A, Kowoll 2014 and 2015). To date, these technic (ADAPT) has never been assessed in a randomized controlled trial.

We have previously conducted a comparative observational study between two recanalization strategies by thrombectomy using first-line ADAPT or the most widely used stent retriever. The interventional neuroradiologist could, in case of recanalization failure with the Solitaire system, used another thrombectomy material left to the operator's choice. 244 consecutive patients on two centers (Rothschild Foundation, and Foch Hospital, France) admitted for a cerebral infarction associated with proximal occlusion were included. This is so far the largest series of patients with ADAPT system. The complete recanalization rate was 84% with ADAPT versus 68% with stent retriever (P = 0.006). Unpublished data, Oral presentation at the European Stroke Organization, April 2015). Our research aims to show that a first line strategy of recanalization by thrombectomy using a distal suction system (ADAPT) is superior that the use of a stent retriever.


Condition or disease Intervention/treatment Phase
Ischemic Cerebrovascular Accident Procedure: direct aspiration procedure Procedure: stent retriever procedure Not Applicable

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 381 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Actual Study Start Date : October 10, 2015
Actual Primary Completion Date : October 2016
Actual Study Completion Date : February 2017

Arm Intervention/treatment
Experimental: ADAPT Procedure: direct aspiration procedure
Revascularization by endovascular thrombectomy using the distal aspiration first pass technique

Active Comparator: Stent Retriever Procedure: stent retriever procedure
Revascularization by endovascular thrombectomy using a mechanical thrombectomy device




Primary Outcome Measures :
  1. Complete recanalization percentage [ Time Frame: Immediately after the revascularization procedure is completed ]
    Proportion of patients in which complete recanalization is achieved as defined by a TICI score equal to 2b or 3



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age > 18 years with no upper age limit.
  • Cerebral infarction in the anterior circulation
  • Occlusion of the anterior circulation proven by CT angiography or MR angiography
  • With or without previous Intravenous thrombolysis
  • Start of thrombectomy procedure within 6 hours of symptoms onset.
  • Patient expresses verbally his non-opposition to be enrolled in the study ; in case patient cannot communicate, verbal non-opposition is obtained from his close / trusted person

Exclusion Criteria:

  • Absence of indication for thrombectomy
  • Cons-indication for thrombectomy
  • Presence of cerebral infarction of the posterior circulation
  • Occlusion of the cervical carotid artery
  • Allergy to x-ray contrast products
  • Patient was bedridden or using a wheelchair most of the day (pre-event modified Rankin Scale score > 3) prior to stroke
  • Pregnancy or breastfeeding
  • Patient under legal protection
  • No affiliation to health insurance

Secondary exclusion criteria

- Lack of access route for catheterization


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02523261


Locations
France
CHU Pellegrin
Bordeaux, France
Hospices Civils de Lyon
Bron, France
CHU Dupuytren
Limoges, France
CHU Hôpital Gui de Chaulac
Montpellier, France
Hôpital Neurologique
Nancy, France
Hôpital Guillaume et René LAENNEC
Nantes, France
Fondation Ophtalmologique Adolphe de Rothschild
Paris, France, 75019
Hôpital Foch
Suresnes, France
Sponsors and Collaborators
Fondation Ophtalmologique Adolphe de Rothschild
Investigators
Principal Investigator: Michel PIOTIN Fondation ophtalmologique de Rothschild

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Fondation Ophtalmologique Adolphe de Rothschild
ClinicalTrials.gov Identifier: NCT02523261     History of Changes
Other Study ID Numbers: MPN_2015_22
First Posted: August 14, 2015    Key Record Dates
Last Update Posted: February 8, 2018
Last Verified: February 2018

Additional relevant MeSH terms:
Ischemia
Stroke
Cerebral Infarction
Pathologic Processes
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Brain Infarction
Brain Ischemia