Stroke is a leading cause of death and disability worldwide. The introduction of mechanical thrombectomy has revolutionized the treatment of acute ischemic stroke caused by large vessel occlusions. In recent years, direct aspiration first pass technique (ADAPT) has emerged as one of the most successful thrombectomy strategies. It involves using a large lumen catheter to directly aspirate the clot from the cerebral vessel without the need for stent retriever. This technique has been demonstrated to improve patient outcomes and reduce procedural times, making it an attractive option for stroke treatment.
ADAPT uses a combination of a large lumen aspiration catheter, a microcatheter, and a guide catheter to aspirate the thrombus and safely remove it from the affected cerebral artery. The large lumen aspiration catheter is inserted via the femoral artery and navigated to the thrombus using a guide catheter. To achieve complete aspiration of the thrombus in a single pass, a balloon guide catheter is used to re-establish blood flow through the affected artery. The ADAPT technique differs from other thrombectomy techniques as it does not implement a stent-retriever strategy, but relies solely on suction.
Studies show that ADAPT has high success rates in achieving proven favorable outcomes for patients with acute ischemic stroke. It has demonstrated comparable efficacy to stent retriever techniques, but offers a more simplified treatment approach and lessens the need for adjunctive strategies such as balloon angioplasty or the use of tPA (tissue plasminogen activator). Additionally, ADAPT has been demonstrated to have significantly shorter procedure times, resulting in reduced exposure to contrast or radiation.
One of the advantages of the ADAPT technique is that it is a more forgiving stroke thrombectomy approach. The technique allows for the removal of highly organized or mature thrombus, which can often be resistant to stent retriever treatment. This is because a significant portion of the ADAPT challenge is the manual control of flow in the guide catheter to establish optimal suction strength on the entire thrombus. Additionally, ADAPT can be applied to a variety of intracranial vessels, including proximal and distal cerebral arteries.
Another benefit of the ADAPT technique is that it can easily be integrated into existing thrombectomy strategies. As current treatment options lean heavily on stent-retriever techniques, the ADAPT technique can offer an alternative or viable augmentation, demonstrating the flexibility of mechanical thrombectomy. In addition, using ADAPT is straightforward, and can be easily implemented, minimizing the risk for complications associated with the procedure.
In conclusion, the direct aspiration first pass technique (ADAPT) for stroke thrombectomy offers a simplified thrombectomy technique that is both effective and efficient. It has been shown to have high rates of success in patients with acute ischemic stroke, and reduces procedural time while minimizing the need for adjunctive strategies. ADAPT is an innovative and valuable technique which allows physicians to improve patient outcomes with a more forgiving, comprehensive approach to thrombectomy.