Purpose To report the efficacy of A Direct Aspiration first-Pass Thrombectomy (ADAPT) technique with evolving ACE aspiration catheter technology as first-line treatment for anterior circulation emergent large vessel occlusions (ELVOs) and assess for the presence of a first pass effect with ADAPT.

Methods We retrospectively reviewed 152 consecutive patients with anterior circulation ELVOs treated with the ADAPT technique as first-line treatment using ACE 60, 64 or 68 at our institution. Baseline characteristics, procedural variables, and modified Rankin Scale (mRS) at 90 days were recorded.

Results Fifty-seven patients were treated with ACE 60 (37.5%), 35 with ACE 64 (23%) and 60 with ACE 68 (39.5%). Median groin puncture to reperfusion time was 30 min with ACE 60, 26 min with ACE 64, and 19.5 min with ACE 68. Successful reperfusion after the first ADAPT pass was 33% with ACE 60% and 53% with ACE 68 (p=0.04). Of note, successful reperfusion after the first ADAPT pass was achieved in 23 of 33 patients with M1 occlusions treated with ACE 68 in our cohort (69.7%). The stent-retriever rescue rate was 26% with ACE 60, 3% with ACE 64% and 10% with ACE 68 (p=0.004). The rate of embolus to a new territory was 5.3% with ACE 60, 2.9% with ACE 64% and 1.7% with ACE 68 (p=0.5). The rate of intracranial vascular injury was 1.8% with ACE 60, 5.7% with ACE 64% and 5% with ACE 68 (p=0.5). The symptomatic intracranial hemorrhage rate was 1.8% with ACE 60, 5.7% with ACE 64% and 6.7% with ACE 68 (p=0.4). At 90 days, a good clinical outcome, mRS 0–2, was achieved in 70 patients (46.1%), while 27 patients had mRS 3 (17.8%), 22 mRS 4–5 (14.5%), and 33 expired (21.7%). In multivariate logistic regression analysis, use of the ACE 68 aspiration catheter was an independent predictor of successful reperfusion after the first ADAPT pass (p-value 0.016, OR 1.67, 95% CI 1.1–2.54), while successful reperfusion after the first ADAPT pass was an independent predictor of good clinical outcome at 90 days (p-value 0.0004, OR 6.2, 95% CI 2.27–16.8).

Conclusion Use of the ACE 68 aspiration catheter was associated with shorter groin puncture to reperfusion times, higher rates of successful reperfusion after the first ADAPT pass, and lower rates of stent-retriever rescue. Further, a first pass effect was demonstrated in our ADAPT patient cohort.

Disclosures J. Delgado Almandoz: 2; C; Penumbra, Inc. Y. Kayan: 2; C; Penumbra, Inc. A. Wallace: None. R. Tarrel: None. J. Fease: None. J. Scholz: None. A. Milner: None. P. Roohani: None. M. Mulder: None. M. Young: None.