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Background and Purpose: The technique of A Direct Aspiration, First Pass for the Endovascular Treatment of Stroke (ADAPT) has been reported to be fast, safe and effective for the treatment of acute ischemic stroke(AIS). The aim of this study is to determine the preoperative factors that affect success of the aspiration component of the technique in ischemic stroke patients with large vessel occlusion in the anterior circulation.Methods: We enrolled all 347 consecutive patients with anterior circulation AIS admitted for mechanical thrombectomy (MT) at our institution from August 2013 to October 2015 and treated by ADAPT. Baseline and procedural characteristics, mTICI scores and 3-month mRS were captured and analyzed.Results: Among the 347 patients (occlusion sites: MCA=200, 58%; ICA Siphon=89, 25%; Tandem=58, 17%), aspiration component led to successful reperfusion (mTICI 2b/3 scores) in 56% (193/347 patients), stent retrievers were required in 40 % and a total successful final reperfusion rate of 83% (288/345) was achieved. Overall mRS 0-2 at 90 days was reported in 45% (144/323). Only two factors positively influenced the success of the aspiration component: an isolated MCA occlusion (p<0.001) and a shorter time from stroke onset to clot contact (p=0.018). Overall procedural complications occurred in 13.3% of patients (48/345).Conclusion: In this large retrospective study, ADAPT technique was shown to be safe and effective for anterior circulation AIS with a final successful reperfusion achieved in 83%. Delay from onset to clot contact and the site of arterial occlusion were predictors for reperfusion.