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Original research
Endovascular thrombectomy first-pass reperfusion and ancillary device placement
  1. Pedro Navia1,2,
  2. Mariano Espinosa de Rueda3,
  3. Amado Rodriguez-Benitez4,
  4. Federico Ballenilla Marco5,
  5. José Manuel Pumar6,
  6. Jose Ignacio Gallego-Leon7,8,
  7. Jose Luis Diaz-Valiño9,
  8. Jose Carlos Mendez10,
  9. Francisco Hernández Fernández11,
  10. Carlos Manuel Rodriguez-Paz12,
  11. David Hernandez13,
  12. Franscisco Javier Maynar14,
  13. Juan Vega-Villar15,
  14. Juan Manuel García-Benassi16,
  15. Mario Martínez-Galdámez17,18,
  16. Jose-Angel Larrea19,
  17. Andres Fernandez-Prieto1,2
  1. 1Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
  2. 2La Paz University Hospital Health Research Institute, Madrid, Spain
  3. 3Interventional Neuroradiology, Virgen de la Arrixaca University Hospital, El Palmar, Spain
  4. 4Hospital Universitario Puerta del Mar, Cadiz, Spain
  5. 5Hospital Universitario 12 de Octubre, Madrid, Spain
  6. 6Neuroradiology, University of Santiago de Compostela, Santiago de Compostela, Spain
  7. 7Alicante General University Hospital, Alicante, Spain
  8. 8Alicante Institute for Health and Biomedical Research, Alicante, Spain
  9. 9Complexo Hospitalario Universitario A Coruña, A Coruna, Spain
  10. 10Interventional Neuroradiology Unit. Radiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
  11. 11Complejo Hospitalario Universitario de Albacete, Albacete, Spain
  12. 12Complexo Hospitalario Universitario de Vigo, Vigo, Spain
  13. 13Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
  14. 14Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
  15. 15Hospital Universitario de la Princesa, Madrid, Spain
  16. 16University Hospital of Toledo, Toledo, Spain
  17. 17Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
  18. 18Interventional Neuroradiology.Radiology Department, Hospital La Luz, Quironsalud, Madrid, Spain
  19. 19Interventional Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain
  1. Correspondence to Dr Pedro Navia, Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid 28046, Spain; pnavia1{at}


Background Recent randomized trials have demonstrated the efficacy of mechanical thrombectomy in treating acute ischemic stroke, however, further research is required to optimize this technique. We aimed to evaluate the impact of guide catheter position and clot crossing on revascularization rates using A Direct Aspiration First Pass Technique (ADAPT).

Methods Data were collected between January 2018 and August 2019 as part of the Spanish ADAPT Registry on ACE catheters (SARA), a multicenter observational study assessing real-world thrombectomy outcomes. Demographic, clinical, and angiographic data were collected. Subgroup analyses assessed the relationship between guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores. First pass effect (FPE) was defined as mTICI 3 after single pass of the device.

Results From a total of 589 patients, 80.8% underwent frontline aspiration thrombectomy. The median score on the National Institutes of Health Stroke Scale (NIHSS) was 16.0. After adjusting for confounders, the likelihood of achieving FPE (adjusted Odds Ratio (aOR), 0.587; 95% confidence interval (CI), 0.38 to 0.92; p=0.0194) were higher among patients with more distal petrocavernous placement of guide catheter. The likelihood of achieving FPE (aOR, 0.592; 95% CI, 0.39 to 0.90; p=0.0138) and final angiogram complete reperfusion (aOR, 0.465; 95% CI, 0.30 to 0.73; p=0.0008) were higher among patients without microguidewire crossing the clot. No difference was noted for time from arterial puncture to reperfusion in any study group. At the 90-day follow-up, the mortality rate was 9.2% and 65.8% of patients across the entire study cohort were functionally independent (modified Rankin Scale (mRS) 0–2).

Conclusions Petrocavernous guide catheter placement improved first-pass revascularization. Crossing the occlusion with a microguidewire lowered the likelihood of achieving FPE and complete reperfusion after final angiogram.

  • Stroke
  • Thrombectomy
  • Technique

Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.

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  • Contributors All authors contributed to the conception and design of the study and critically reviewed and approved the manuscript. PN and AFP contributed to drafting the text and preparing the figures. PN is the guarantor of the current work.

  • 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 None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.