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Original research
Impact of reperfusion pump power on technical and clinical outcomes after direct aspiration thrombectomy (ADAPT)
  1. Ali Alawieh1,2,
  2. Reda Chalhoub1,
  3. Clayton J Korson1,
  4. Mohammad Anadani3,
  5. Jonathan Lena1,
  6. Alejandro Spiotta1
  1. 1Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Neurosurgery, Emory University, Atlanta, Georgia, USA
  3. 3Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Alejandro Spiotta, Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, United States; spiotta{at}


Introduction Higher aspiration forces using larger bore catheters in direct aspiration thrombectomy (ADAPT) have been associated with shorter procedure time and better outcomes in patients treated for acute ischemic stroke (AIS). However, the effect of using reperfusion pumps of higher aspiration power on outcomes of ADAPT has not been investigated. We evaluated the effect of using pumps with different aspiration powers on technical and clinical outcomes after ADAPT.

Methods We reviewed a retrospective database of AIS cases between January 2018 and February 2019, while comparing technical and clinical outcomes between patients undergoing ADAPT using the MAX pump (28.5 inHg power) vs the ENGINE pump(29.2 inHg power).

Results Among 194 patients (48% females, age 69±15 years) included in the study, 73 patients undergoing ADAPT using the ENGINE pump were age-, gender-, comorbidities-, and operator-matched to 118 patients treated using the MAX pump. The ENGINE group had shorter procedure time (20±17 vs 27±21 mins, p=0.017), lower number of aspiration attempts (2.2±1.6 vs 2.8±1.9, p=0.047), and similar rates of favorable 90 day modified Rankin Scale. Using multivariate linear regression, the use of the ENGINE reperfusion pump with higher vacuum power was independently and inversely correlated with procedure time (coefficient −2.23, p=0.027). While controlling for confounders, there was a trend toward an inverse correlation between use of the ENGINE pump and the number of attempts on linear regression (coefficient −1.04, p=0.09) and lower odds of PH2/intracranial (ICH) hemorrhages on logistic regression (OR 0.227, p=0.075).

Conclusion Our findings suggest that the use of the ENGINE reperfusion pump of higher aspiration power during ADAPT decreases procedure time, without increasing complications and post-procedural hemorrhage rates.

  • large vessel occlusion
  • stroke
  • ADAPT thrombectomy
  • aspiration thrombectomy
  • procedure time

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  • Contributors Each author listed should receive authorship credit based on the material contribution to this article, their revision of this article and their final approval of this article for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JL: consultant–Penumbra. AS: consultant–Penumbra, Stryker, Cerenovus, research support–Penumbra, Stryker, Cerenovus.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board at the Medical University of South Carolina under expedited review with informed consent waived given the retrospective nature of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.