Aristotle-Only Direct Aspiration First-Pass Technique (AO-ADAPT) for Endovascular Mechanical Thrombectomy: A Technical Series of a Novel Technique Demonstrating Safety and Efficacy

Background The introduction of soft, large-profile microwires has improved aspiration catheter delivery for intracranial large-vessel occlusions. The Aristotle-only direct aspiration first-pass technique (AO-ADAPT) uses the Aristotle 24 microwire to deliver a large-bore aspiration catheter to the target occlusion without a microcatheter. We characterized rates of technical success achieved using this technique for mechanical aspiration thrombectomy. Methods A retrospective review of prospectively collected thrombectomy databases at 4 academic institutions identified patients undergoing procedures in which AO-ADAPT was used. Patient demographics, clinical considerations, technical details, and radiographic outcomes were collected. Rates of successful aspiration catheter delivery without adjunctive devices and of successful reperfusion (Thrombolysis in Cerebral Infarction >= 2B) were collected. Results Forty-five patients met inclusion criteria (mean age 72.2 +/- 13.2 years, 62.2% female; 71.1% M1 occlusions). With a first-line AO-ADAPT approach, 42/45 (93.3%) patients achieved Thrombolysis in Cerebral Infarction >= 2B reperfusion, with first-pass recanalization in 26/45 (57.8%). We delivered the aspiration catheter to the target occlusion without adjunctive device in 35/45 (77.8%) patients. Of these, 29 (82.9%) underwent successful contact aspiration. This entire cohort (64.4% of the population) achieved Thrombolysis in Cerebral Infarction >= 2B, with a mean time to reperfusion of 16 minutes and a first-pass recanalization rate of 66%. Of the 16 patients who did not achieve successful AO-ADAPT reperfusion, 6 needed a microcatheter for aspiration catheter delivery but underwent successful contact aspiration, 6 achieved microcatheter-free delivery but needed a stentriever for final recanalization, and 4 required both microcatheter for delivery and stentriever for final recanalization. No intracranial vascular complications occurred during the procedures; 1 patient (2.2%) experienced symptomatic intracranial hemorrhage secondary to reperfusion injury. Conclusion The AO-ADAPT approach to mechanical thrombectomy safely and effectively achieved reperfusion for patients with large-vessel occlusions, with first-pass success and successful recanalization rates comparable with other techniques. For most cases in this series, this technique obviated the need for a microcatheter and/or stentriever.