Vol.:(0123456789) 1 3 La radiologia medica https://doi.org/10.1007/s11547-019-01069-x EMERGENCY RADIOLOGY Efcacy of ADAPT with large‑bore reperfusion catheter in anterior circulation acute ischemic stroke: a multicentric Italian experience Daniele Giuseppe Romano 1  · Giulia Frauenfelder 2  · Tommaso Casseri 3  · Mariangela Piano 4  · Sergio Vinci 5  · Alessio Comai 6  · Alessandro Stecco 7  · Francesco Causin 8  · Francesco Asteggiano 9  · Aldo Paolucci 10  · Chiara Comelli 11  · Andrea Giorgianni 12  · Luigi Cirillo 13  · Giuseppe Ganci 14  · Samuele Cioni 3  · Antonio Pitrone 5  · Guglielmo Pero 4  · Rosario Papa 5  · Mario Muto 15  · Renato Saponiero 1  · Sandra Bracco 3 Received: 9 April 2019 / Accepted: 6 August 2019 © Italian Society of Medical Radiology 2019 Abstract Introduction A direct aspiration frst pass technique (ADAPT) is an alternative technique as frst-line thrombectomy for large vessel occlusion in acute ischemic stroke, still debated when compared to frst-line stent retriever. To retrospectively evaluate technical and clinical outcomes of the ADAPT as frst-line treatment for anterior circulation acute ischemic stroke with large-bore reperfusion catheters. Methods A multicentric data collection from 14 medical centers was retrospectively analyzed. Large-bore catheters had a distal diameter between 0.64 and 0.71 in; stent retriever was added when aspiration alone failed. Baseline characteristics, technical and clinical variables were collected, including NIHSS, thrombolysis in cerebral infarction (TICI), peri-procedural complications, 90-day mRS and 90-day mortality. Results Overall, 501 patients were treated. No statistically signifcant diference in terms of baseline features or tPA adminis- tration was recorded between patients treated with ADAPT and with additional stent retriever. ADAPT alone was successful in achieving TICI ≥ 2b in 71.8% with a median of 1.55 aspiration attempts. In terms of TICI ≥ 2b, ADAPT alone was better than additional stent retriever (p < 0.001), while no statistical diference was achieved from catheter diameter. Embolization to a new territory was less frequent in ADAPT group (5.2 vs 18%; p = 0.0026). Patients treated with ADAPT alone had better clinical outcomes in terms of mRS ≤ 2 (p < 0.001). Conclusions ADAPT is a valid technique with respect to the rates of TICI 2b/3 recanalization and 90-day mRS scores. In this series, an attempt at recanalization with ADAPT with larger-bore reperfusion catheter may be warranted prior to sten- triever thrombectomy. Keywords Angiography · Stroke · Thrombectomy · Catheter Abbreviations ADAPT A direct aspiration frst pass technique ASPECTS Alberta stroke program early CT score CTA CT angiography DWI Difusion-weighted imaging EVT Endovascular therapy ICA Internal carotid artery MCA Middle cerebral artery mRS Modifed Rankin Scale MT Mechanical thrombectomy NIHSS National Institutes of Health Stroke Scale sICH Symptomatic intracranial hemorrhage TICI Thrombolysis in cerebral infarction tPA Tissue plasminogen activator Introduction Treatment of acute ischemic stroke has evolved remark- ably in the past decade. Several randomized stroke clini- cal trials [1–5] demonstrated the superiority of mechanical thrombectomy (MT) from large vessel occlusion when com- pared with the standard intravenous thrombolysis alone in patients with acute stroke. Compared with other endovascu- lar approaches, the technique of a direct aspiration frst pass technique for the endovascular treatment of stroke (ADAPT) * Giulia Frauenfelder g.frauenfelder@unicampus.it Extended author information available on the last page of the article