Direct Aspiration as First-Line Technique for Acute Intracranial Internal Carotid Artery Occlusion: Preliminary Results
10.5469euroint.2025.01200
- Author:
Miguel RAMÍREZ-TORRES
1
;
Blanca FUENTES
;
Andrés FERNÁNDEZ-PRIETO
;
Alberto ÁLVAREZ-MUELAS
;
Andrés Javier BARRIOS
;
Remedios FRUTOS
;
Cristina UTRILLA
;
Marc COMAS-CUFI
;
Josep PUIG
;
Pedro NAVIA
Author Information
1. Department of Radiology, La Paz University Hospital, Madrid, Spain
- Publication Type:Original Paper
- From:Neurointervention
2026;21(1):6-18
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Acute intracranial internal carotid artery (ICA) occlusion has high clot burden and poor outcomes. No consensus exists on optimal first-line mechanical thrombectomy (MT) using direct aspiration first pass technique (ADAPT), stent retriever (SR) alone, or combined thrombectomy (non-ADAPT). We compared outcomes between ADAPT and non-ADAPT strategies for ICA occlusion.
Materials and Methods:Data were collected from a comprehensive stroke center between January 2019 and August 2024. Patients with intracranial ICA occlusions were divided into ADAPT and non-ADAPT groups. Demographic, clinical, angiographic, and clinical outcomes (National Institute of Health Stroke Scale [NIHSS] score at 24 hours and modified Rankin Scale [mRS] score at 3 months) were compared. Good functional outcome was defined as a mRS score of 0–2.
Results:Of 85 patients (mean age, 75 years; 47% females), 60 (70.6%) received ADAPT and 25 (29.4%) non-ADAPT (18 with aspiration and SR combined and 7 with SR alone). ADAPT achieved successful recanalization with shorter procedure time (median, 32 minutes vs. 60 minutes, P=0.001), higher modified Treatment In Cerebral Ischemia (mTICI) recanalization rates (final mTICI 2c-3, 75% vs. 52%; P=0.038; mTICI 2b-3, 98.3% vs. 88%; P=0.074), and better outcomes at 3 months (mRS ≤2, 47% vs. 22%; P=0.039). Multivariate analysis showed NIHSS at discharge as the only significant predictor of good functional outcome at 3 months (odds ratio [OR] 0.68, P<0.001), while ADAPT exhibited a trend toward significance (OR 5.10, P=0.075).
Conclusion:ADAPT exceeded other strategies for intracranial ICA occlusion as first-line technique, achieving faster recanalization and potentially impacting long-term functional outcome.
