Introduction: The ADAPT (a direct aspiration first pass technique for acute stroke thrombectomy), using large bore aspiration catheters, has been reported to be a fast, safe, simple and effective method of mechanical thrombectomy (MT) that has facilitated the treatment of acute ischemic strokes.
Hypothesis: An attempt to determinate the favorable factors leading to a satisfactory reperfusion (TICI 2b/3) with ADAPT in anterior circulation ischemic stroke patients with confirmed large vessel occlusions.
Methods: Based on our prospectively gathered database we extracted patients who were admitted for MT in anterior circulation ischemic strokes since August 2013 and for whom ADAPT was used as the first MT option. Patient demographics, initial NIHSS, localization and lateralization of the occlusion, DWI-ASPECTS, IV thrombolysis prior to MT, time from stroke onset to femoral puncture, final TICI score and 3-month mRS were analyzed.
Results: ADAPT was effective in achieving a TICI2b/3 in 54.7% of 309 patients. Two factors influenced positively the success of reperfusion with ADAPT as a stand alone procedure: an isolated MCA occlusion (p<0.0001) and a shorter time from stroke onset to femoral puncture (p=0.0156). Age, Gender, initial NIHSS, DWI-ASPECTS and IV thrombolysis prior to MT did not influence the success of the ADAPT procedure. The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 84.1% (p<0.0001). When ADAPT was the sole technique used to achieve satisfactory reperfusion, 3-month mRS≤2 was achieved in 70.4% of the patients, while only 41.7% of mRS≤2 at 3-month was achieved in patients for whom ADAPT then stent retrievers were used (p=0.0001).
Conclusions: ADAPT is very effective in case of isolated MCA occlusion ischemic strokes. The relevance of ADAPT over stent retrievers in other anterior circulation localizations (carotid siphon and tandem occlusions) has to be evaluated with a randomized study.