First attempt recanalization with ADAPT: rate, predictors, and outcome

Area of Science:

• Endovascular therapy
• Neurointerventional surgery
• Cerebrovascular disease management

Background:

• First-attempt recanalization (FAR) rates with aspiration thrombectomy devices are not well-established.
• The impact of FAR on patient outcomes following mechanical thrombectomy requires further understanding.

Purpose of the Study:

• To determine the FAR rate using the direct aspiration first pass technique (ADAPT).
• To analyze the association between FAR and clinical outcomes.
• To identify predictors of successful FAR.

Main Methods:

• Analysis of the ADAPT database for patients achieving FAR.
• Collection of baseline, procedural, and postprocedural variables.
• Multivariate logistic regression to identify FAR predictors and assess outcomes (90-day mRS, mortality, hemorrhage).

Main Results:

• 178 of 524 patients (34.0%) achieved FAR.
• FAR group showed higher IV tPA use (46.6% vs 37.6%), improved functional independence (53% vs 37%), and lower mortality and hemorrhage rates.
• Predictors of FAR included IV tPA, non-tandem occlusion, and larger catheters (anterior circulation); diabetes, onset-to-groin time, and cardioembolic etiology (posterior circulation).

Conclusions:

• FAR is associated with significantly better functional outcomes and reduced mortality after mechanical thrombectomy.
• Utilizing larger aspiration catheters and pretreatment IV tPA when indicated can enhance FAR rates with ADAPT.