title: A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study.
abstract: OBJECTIVE
  Mechanical thrombectomy with stent retrievers is now the standard therapy for selected patients with ischemic stroke. The technique of A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke (ADAPT) appears promising with a high rate of recanalization. We compared ADAPT versus stent retrievers (the Solitaire device) for efficacy and safety as a front-line endovascular procedure.
  
  
  METHODS
  We analyzed 243 consecutive patients with large intracranial artery occlusions of the anterior circulation, treated within 6 hours with mechanical thrombectomy by either ADAPT or the Solitaire stent. Th primary outcome was complete recanalization (modified TICI ≥ 2b); secondary outcomes included complication rates and procedural and clinical outcomes.
  
  
  RESULTS
  From November 2012 to June 2014, 119 patients were treated with stent retriever (Solitaire FR) and 124 by using the ADAPT with Penumbra reperfusion catheters. The median baseline NIHSS score was the same for both groups (Solitaire, 17 [interquartile range, 11-21] versus ADAPT, 17 [interquartile range, 12-21]). Time from groin puncture to recanalization (Solitaire, 50 minutes [range, 25-80 minutes] versus ADAPT, 45 minutes [range, 27-70 minutes],P= .42) did not differ significantly. However, compared with the Solitaire group, patients treated with ADAPT achieved higher final recanalization rates (82.3% versus 68.9%; adjusted relative risk, 1.18; 95% CI, 1.02-1.37;P= .022), though differences in clinical outcomes between the cohorts were not significant. Use of an adjunctive device was more frequent in the ADAPT group (45.2% versus 13.5%,P< .0001). The rate of embolization in new territories or symptomatic hemorrhage did not differ significantly between the 2 groups.
  
  
  CONCLUSIONS
  Front-line ADAPT achieved higher recanalization rates than the Solitaire device. Further randomized controlled trials are warranted to define the best strategy for mechanical thrombectomy.
authors.affiliation: From the Division of Neurology (B.L., J.-P.D., F.B.), Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France b.lapergue@hopital-foch.org.
authors.forename: B
authors.identifier: http://orcid.org/0000-0002-8993-2175
authors.initials: B
authors.lastname: Lapergue
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France.
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-0086-8614
authors.initials: R
authors.lastname: Blanc
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology (P.G., O.C., G.R.), Foch Hospital, Suresnes, France.
authors.forename: P
authors.identifier: http://orcid.org/0000-0002-9694-6102
authors.initials: P
authors.lastname: Guedin
authors.affiliation: From the Division of Neurology (B.L., J.-P.D., F.B.), Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: J-P
authors.identifier: http://orcid.org/0000-0001-9064-1503
authors.initials: JP
authors.lastname: Decroix
authors.affiliation: Department of Biostatistics (J.L.), Univiversity of Lille, Centre Hospitalier Universitaire Lille, Santé Publique: Epidémiologie et Qualité des Soins, Lille, France.
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-3384-0423
authors.initials: J
authors.lastname: Labreuche
authors.affiliation: Laboratoire de Mathématiques Paul Painlevé (C.P.), Unité Mixte de Recherche CNRS 8524, Lille, France.
authors.forename: C
authors.identifier: http://orcid.org/0000-0001-6787-7374
authors.initials: C
authors.lastname: Preda
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France.
authors.forename: B
authors.identifier: http://orcid.org/0000-0001-6055-0221
authors.initials: B
authors.lastname: Bartolini
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology (P.G., O.C., G.R.), Foch Hospital, Suresnes, France.
authors.forename: O
authors.identifier: http://orcid.org/0000-0002-9968-358X
authors.initials: O
authors.lastname: Coskun
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France.
authors.forename: H
authors.identifier: http://orcid.org/0000-0002-6943-9922
authors.initials: H
authors.lastname: Redjem
authors.affiliation: Department of Neurology and Stroke Center (M.M.), Lariboisière Hospital, Paris, France.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-0911-8999
authors.initials: M
authors.lastname: Mazighi
authors.affiliation: From the Division of Neurology (B.L., J.-P.D., F.B.), Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-0757-1346
authors.initials: F
authors.lastname: Bourdain
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology (P.G., O.C., G.R.), Foch Hospital, Suresnes, France.
authors.forename: G
authors.identifier: http://orcid.org/0000-0001-5858-9522
authors.initials: G
authors.lastname: Rodesch
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology (R.B., B.B., H.R., M.P.), Rothschild Foundation, Paris, France.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-1354-4328
authors.initials: M
authors.lastname: Piotin