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Direct Aspiration as First-Line Technique for Acute Intracranial Internal Carotid Artery Occlusion: Preliminary

Miguel Ramírez-Torres1, Blanca Fuentes2,3, Andrés Fernández-Prieto3,4

  • 1Department of Radiology, La Paz University Hospital, Madrid, Spain.

Neurointervention
|January 28, 2026
PubMed

Insights

Direct aspiration first pass technique (ADAPT) offers faster recanalization for acute intracranial internal carotid artery occlusion. This mechanical thrombectomy approach may improve long-term functional outcomes in stroke patients.

Area of Science:

  • Neurology
  • Interventional Neurology
  • Vascular Neurology

Background:

  • Acute intracranial internal carotid artery (ICA) occlusion presents a significant challenge due to high clot burden and poor patient outcomes.
  • Mechanical thrombectomy (MT) is a primary treatment, but optimal first-line strategies, including direct aspiration first pass technique (ADAPT) and stent retriever (SR) techniques, remain debated.

Purpose of the Study:

  • To compare the effectiveness of ADAPT versus non-ADAPT (SR alone or combined aspiration-thrombectomy) strategies as a first-line treatment for acute intracranial ICA occlusions.
  • To evaluate procedural efficiency, recanalization rates, and functional outcomes in patients undergoing MT for ICA occlusion.

Main Methods:

  • A retrospective analysis of 85 patients with intracranial ICA occlusions treated between January 2019 and August 2024 at a comprehensive stroke center.
  • Patients were categorized into ADAPT and non-ADAPT groups, with outcomes assessed using the National Institute of Health Stroke Scale (NIHSS) at 24 hours and modified Rankin Scale (mRS) at 3 months.
  • Good functional outcome was defined as an mRS score of 0-2.

Main Results:

  • ADAPT was used in 70.6% of patients (n=60) and non-ADAPT in 29.4% (n=25).
  • ADAPT demonstrated significantly shorter procedure times (32 vs. 60 minutes, P=0.001) and higher successful recanalization rates (mTICI 2c-3: 75% vs. 52%, P=0.038).
  • Patients treated with ADAPT showed better functional outcomes at 3 months (mRS ≤2: 47% vs. 22%, P=0.039). NIHSS at discharge was the sole significant predictor of good functional outcome.

Conclusions:

  • ADAPT emerged as a superior first-line mechanical thrombectomy strategy for intracranial ICA occlusions compared to non-ADAPT techniques.
  • ADAPT facilitates faster recanalization and is associated with improved long-term functional outcomes.
  • Further research may solidify ADAPT's role in optimizing stroke treatment protocols.
Abstract

Keywords:
AspirationCarotid artery, internalStentrieverStrokeThrombectomy

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