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Letters to the Editor
ADAPT FAST Study: third-generation stroke thrombectomy devices place renewed focus on the elusive relationship between revascularization and good outcomes
  1. Brijesh P Mehta1,
  2. Thabele M Leslie-Mazwi2,
  3. Claus Z Simonsen3,
  4. James D Rabinov3,
  5. Joshua A Hirsch4,
  6. Rishi Gupta5,
  7. Albert J Yoo6
  1. 1Department of NeuroInterventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Neurointerventional Service, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Department of NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  6. 6Department of Interventional and Diagnostic Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Brijesh Mehta, Department of NeuroInterventional Radiology, Massachusetts General Hospital, 55 Fruit St Gray 241, Boston, MA 02114, USA; brijesh.mehta{at}icloud.com

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We commend the authors for demonstrating the effectiveness of the ADAPT technique for the rapid revascularization of proximal intracranial occlusions.1 The overall 78% rate of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 reperfusion and the ultrashort procedural time to revascularization support the Penumbra 5MAX and 5MAX ACE aspiration catheters as first-line interventional tools alongside stent retrievers.

There are several points worth mentioning regarding the design and reporting of this study:

  1. Evaluation of angiographic outcomes: as the authors admit, it is critical that studies that use revascularization as a primary endpoint have their angiographic results adjudicated by a blinded core imaging laboratory. The SWIFT study has shown us that self-adjudication is biased towards inflated measures of procedural success.2

  2. Good clinical outcome rates in context: in their discussion the authors compare the clinical results of the ADAPT FAST, SWIFT and TREVO 2 studies, all of which report approximately 40% rates of good outcome (modified Rankin Scale score 0–2).1–3 What is more significant, however, is that, despite a near doubling in the rate of meaningful reperfusion (mTICI 2b/3) and faster procedural times with these third-generation devices, there has been no perceptible increase in the rate of good outcomes compared with the IMS III study, …

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