Experience with A Direct Aspiration First Pass Technique (ADAPT) for Thrombectomy in Distal Cerebral Artery Occlusions Causing Acute Ischemic Stroke

Single-Center Experience Using the 3MAX Reperfusion Catheter for the Treatment of Acute Ischemic Stroke with Distal Arterial Occlusions

“…In our series a perforation occurred in this exact location, supporting the fact that adequate assessment of the target vessel is crucial when choosing between ADAPT and stent retriever. Vargas et al [10] proposed a series of 35 patients treated with ADAPT for distal occlusion which was very similar to our study. They reported a TICI 2b/3 rate of 77.1% after ADAPT alone with a conversion rate of 20% to achieve an overall reperfusion rate of 97.1% and reached good clinical outcome in 59.4% of patients at 3 months.…”

“…Literature provides only retrospective series focused on distal occlusions ( Table 2) mainly treated with stent retrievers and displays heterogeneous reperfusion rates (from 70 to 100%) but low complication rates [9,10,[19][20][21][22][23][24]. Navia et al [9] provided a 6 cases series of distal occlusions treated with ADAPT and found a 100% TICI 2b/3 reperfusion rate with a 83% rate of good clinical outcome, no complication and no need to use stent retrievers.…”

“…One must always consider that these catheters can be harmful even on large intracranial arteries especially at junction points or in tortuous segments. In comparison, Vargas et al's [10] series comprised 80% isolated M2 occlusions, one M3 and one A3 occlusion; they reported two major procedure-related complications. In our series, we aimed to reperfuse even very distal occlusions up to A3 (one case), M3 (six cases) and P3 (two cases) which inevitably exposes to a greater risk of complications.…”

“…[7,8] However, only scant data are available for smaller catheters like the 3MAX in distal occlusions. [9,10] The primary endpoint of the study was the successful (i.e. Thrombolysis In Cerebral Infarction [TICI] score 2b/3) reperfusion rate using ADAPT with the 3MAX.…”

Therapeutic Results of a Direct Aspiration First Pass Technique Using the Penumbra 4MAX Aspiration Catheter for Middle Cerebral Artery M2 Occlusion

“…However, in the report by Vargas et al 11) that reviewed 35 patients treated by ADAPT for distal lesions including 28 patients (80.0%) with M2 occlusion, the effective recanalization was achieved in 77.8% by aspiration alone and in 97.1% after a rescue treatment such as the SR, and ADAPT was also considered to be effective for peripheral lesions. In the study, Penumbra 3MAX to 5MAX ACE60 were used as aspiration catheters, and the authors considered that, if they can be guided to the lesion, stronger aspiration force was obtained using larger bore catheters.…”