ADAPT FAST is a fast, effective, versatile mechanical embolectomy technique for acute stroke

Journal of NeuroIntervent Surgery

The multi-institutional prospective data on ADAPT (a direct aspiration first pass technique)-treated stroke patients was reported. ADAPT advances a large guide catheter into ICA for clot aspiration with a large caliber catheter. Other mechanical embolectomy devices are used if first pass failed. Inclusion criteria were large vessel occlusion with viable penumbra and less than 1/3 ischemic vascular territory.  Assessed outcomes included time to successful recanalization, symptomatic ICH, 90 day mRS and mortality, percent TICI 2b/3, and device-related complications. An overall 95% successful revascularization rate, with TICI 2b/3 revascularization at mean of 36.6 +/- 26.4 minutes was achieved for total of 98 patients. ADAPT alone re-canalized 78% of patients at a mean of 31.6 +/- 23.3 minutes. Using adjunct devices significantly prolonged revascularization. Complications included two device-related dissections. No symptomatic ICH was observed.  Observed mortality was 20%, and 40% patients achieved mRS of 0-2 at 90 days, comparable to previous stent retriever studies. Higher recanalization rate was observed with the largest aspiration catheter, 5MAX ACE (0.060 ID) (Penumbra). If first pass fails, ADAPT technique also already positions guide and aspiration catheters for passing alternative clot retrieval devices (i.e. separator or stent retriever).

Michelle J. Smith, MD
Philadelphia, PA