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Updated: Jun 8, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Real-world outcomes of ADAPT using contemporary large-bore aspiration catheters versus combined techniques in acute
Tomoya Goto1, Shunsaku Goto1, Fumie Kinoshita2
1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Background:
Previous randomized trials have demonstrated the non-inferiority of a direct aspiration first-pass technique (ADAPT) over stent retriever-based strategies for acute ischemic stroke (AIS). However, these trials were conducted with earlier-generation aspiration catheters of limited inner diameter, and the comparative effectiveness of ADAPT in the era of contemporary large-bore catheters (≥0.068 in.) remains uncharacterized in real-world settings.
Objective:
To assess the real-world efficacy and safety of ADAPT using current-generation aspiration catheters, including large-bore devices, compared with combined techniques in contemporary mechanical thrombectomy (MT).
Methods:
This multicenter retrospective analysis of a prospectively collected registry included consecutive patients with AIS and large- or medium-vessel occlusions treated between January 2023 and December 2024. Patients who underwent ADAPT or combined techniques as a first-pass strategy were included. Primary outcome was functional independence (modified Rankin Scale [mRS] score of 0-2) at 90 days. Secondary outcomes included angiographic reperfusion, procedural time, and intracranial hemorrhage. Propensity score matching (PSM) was performed to adjust for observed baseline imbalances.
Results:
Among the 1,053 eligible patients, 325 underwent ADAPT and 728 underwent the combined technique. Before matching, ADAPT was associated with higher rates of 90-day mRS 0-2, first-pass and final mTICI 3 reperfusion, and lower rates of intracranial hemorrhage. After PSM (n = 520), the ADAPT group did not show a statistically significant difference in 90-day functional outcomes compared with the combined technique group (mRS 0-2: 45.8% vs. 39.0%, p = 0.131), while demonstrating significantly higher rates of complete reperfusion (first-pass mTICI 3: 37.4% vs. 26.7%, p = 0.011; final mTICI 3: 50.6% vs. 39.4%, p = 0.013) and shorter puncture-to-recanalization time (median 36.5 vs. 45 min, p < 0.001).
Conclusion:
In contemporary practice using current-generation aspiration catheters, including large-bore devices, ADAPT did not show a statistically significant difference in functional outcomes compared with combined techniques, while demonstrating higher rates of complete reperfusion and greater procedural efficiency. These findings support ADAPT as a reasonable and efficient first-line strategy for mechanical thrombectomy in the era of large-bore catheters, although the observational design and operator-driven technique selection warrant confirmation in prospective comparative studies.
