ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy

Abstract

Background The development of new revascularization devices has improved recanalization rates and time, but not clinical outcomes. We report a prospectively collected clinical experience with a new technique utilizing a direct aspiration first pass technique with large bore aspiration catheter as the primary method for vessel recanalization. Methods 98 prospectively identified acute ischemic stroke patients with 100 occluded large cerebral vessels at six institutions were included in the study. The ADAPT technique was utilized in all patients. Procedural and clinical data were captured for analysis. Results The aspiration component of the ADAPT technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 78% of cases. The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 95%. The average time from groin puncture to at least TICI 2b recanalization was 37 min. A 5MAX demonstrated similar success to a 5MAX ACE in achieving TICI 2b/3 revascularization alone (75% vs 82%, p=0.43). Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 17.0 (12.0-21.0) and improved to a median NIHSS score at discharge of 7.3 (1.0-11.0). Ninety day functional outcomes were 40% (modified Rankin Scale (mRS) 0-2) and 20% (mRS 6). There were two procedural complications and no symptomatic intracerebral hemorrhages. Discussion The ADAPT technique is a fast, safe, simple, and effective method that has facilitated our approach to acute ischemic stroke thrombectomy by utilizing the latest generation of large bore aspiration catheters to achieve previously unparalleled angiographic outcomes.

Development of a recalcitrant, large clot burden, bifurcation occlusion model for mechanical thrombectomy

“…Further experiments will help to validate and confirm the recalcitrance of our bifurcation model. This includes the evaluation of different established modalities for thrombectomy, such as the ADAPT (A Direct Aspiration First Pass Technique) 17 and ARTS (Aspiration-Retriever Technique for Stroke) 12 methods, or primary suction thrombectomy (Fig. 4).…”

Rapid Recanalization of Stent Retriever Compared with That of Old-type Aspiration Catheter for Acute Ischemic Stroke

“…In Penumbra thrombectomy, an aspiration catheter with a larger profile diameter must be navigated through the convoluted intracranial artery, especially at the carotid siphon. Although, theoretically, navigability of aspiration catheters has improved since the launch of newer versions, 10) larger catheters still confer difficulty during delivery to the intracranial arteries. A larger profile can also often create a gap between the guide four patients (40.0%) with the old aspiration catheter system, eight (80.0%) in the first stent group, and eight (80.0%) in the second stent group, there was no significant difference in the recanalization success rate among these groups (p = 0.122).…”

“…A recent trial of the a direct aspiration first pass technique (ADAPT) technique using Penumbra MAX/MAX ACE catheters reported that recanalization rates and clinical outcomes were similar to those achieved using stent retrievers. 10) We first used the standard technique with a separator, which was recommended by the manufacturer. Thereafter, we started using the ADAPT technique.…”

Thrombectomy Using Penumbra System for In-stent Reocclusion after Revascularization with Stent for Acute Stroke: A Case Report

“…1) Additionally, high recanalization rates have been reported by the a direct aspiration first pass technique (ADAPT), 7,8) which is a modification of the conventional procedure using the Penumbra system. However, acute occlusion of major intracranial arteries may be caused by embolic lesions that cannot be recanalized by the above devices as well as atherosclerotic lesions and arterial dissection.…”