• Thrombectomy
• Stroke

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, …