Introduction: Endovascular stroke therapy has been revolutionized by the advent of modern devices for thrombectomy. It remains to be determined what is the most safe and effective way to perform stroke thrombectomy. The two most common approaches to thrombectomy currently include: 1-direct aspiration with the additional use of a stent retriever if needed (ADAPT), 2 - primary stent retriever thrombectomy. We aimed to compare radiographic and clinical outcomes in patients with acute stroke from large vessel occlusion (LVO) treated with these two approaches.
Methods: Using the PubMed database, we searched for studies that included patients with acute ischemic stroke from LVO treated with direct aspiration (ADAPT) or primary stent retriever thrombectomy. The literature search included 294 studies, excluding 122 manuscripts. Statistical analysis was performed on 36 publications with a total of 2656 patients that underwent thrombectomy using a stent retriever device and 11 publications with a total of 683 patients that underwent thrombectomy using ADAPT. We compared the proportions of patients with successful recanalization, favorable functional outcomes, intracranial hemorrhage, mortality rates and occurrence of distal embolization in the two treatment groups by calculating chi2 and confidence intervals for odds ratios.
Results: 3339 patients from 47 publications were included in final analysis. There was no difference in age (p=0.7625, 95% CI -2.91–3.94), NIHSS (p=0.1135, 95% CI -3.55-0.39), the use of intravenous thrombolysis (p=0.9631, 95% CI -29.46-30.85), or location of occlusion (internal carotid artery, middle cerebral artery or posterior circulation; p=0.9679) between the two groups. We found no difference in rates of successful recanalization TICI 2b/3 (79.9% with ADAPT vs. 74.9% with primary stent retriever; p=0.4771, 95% CI -0.091-0.191) or good clinical outcome at 3 months defined as mRS 0-2 (51.0% with ADAPT vs. 46.8% with primary stent retriever; p=0.4814, 95% CI -0.161-0.077).
Conclusion: According to our systematic review, endovascular treatment with direct aspiration (ADAPT) and primary stent retriever thrombectomy approaches results in similar radiographic and clinical outcomes in patients with acute stroke from LVO.