Background and objective:
Although mechanical thrombectomy with stentriever is the first choice for endovascular treatment of acute ischemic stroke (AIS) with large vessel occlusion (LVO), other devices may be reasonable according to the guidelines. Therefore, we compare the efficacy of Direct Aspiration First Pass Technique (ADAPT) vs stentriever, in order to be able to adjust to the resources of our health system.

Methods:
We design a multicenter, prospective, non-randomized study (ClinicalTrials.gov Identifier: NCT03407092) in patients with anterior AIS, LVO and less than 8 hours of evolution treated with endovascular rescue techniques: ADAPT using SOFIA® catheter in comparison with the stent retriever system. Baseline characteristics, procedural features, and clinical results were collected during 2017-2018.

Results:
Of 532 patients (mean age 68.4, 42.9% women), 370 (69.5%) were treated with ADAPT and 162 (30.5%) with stentriever as first choice. For primary outcome, the proportion of patients with successful revascularization was 93.5% (n=345) in ADAPT vs 80.2% (n=130) in stentriever (p=0.003). Using only ADAPT, the rate of recanalization TICI2b-3 was 73.8% (n=283). Rescue treatment was used in 87 patients (27.2%) in the aspiration group and 7 patients (4.3%) in stentriever (p<0.001). Median revascularization attempts were 1 (IQR: 1-2) in ADAPT and 2 (IQR: 2-3) in stentriever (P <0.0001). ADAPT first option achieved shorter puncture-recanalization times: 40±41 vs 74±46 min (p<0.01). The rate of independence (mRS 0-2) at 3 months was 63.7% in ADAPT vs 57.9% in stentriever group (p=0.08).

Conclusion:
Although further randomized clinical trials are needed, ADAPT could be more effective, and shorten times and attempts of the procedure.

THROMBECTOMY IN ANDALUCIA USING ASPIRATION (TRIANA) VS STANDARD STENTRIEVER: EFFECTIVENESS OF ENDOVASCULAR THERAPY FOR STROKE