Although the treatment of acute ischemic stroke (AIS) has recently made revolutionary progress, it is still the leading cause of morbidity and mortality in the US adult population. For recanalization treatment of large vessel occlusion (LVO) with a stent retriever (SR) within 24 hours of onset, trials in the past 5 years have obtained level 1A evidence. However, recent randomized controlled trials have found that direct aspiration thrombectomy as a first-line treatment is not inferior to SR thrombectomy in terms of technology and clinical prognosis.
Since 2013, A Direct Aspiration Approach as First Pass Technique (ADAPT) has been introduced, which can provide rapid recanalization and reduce the cost of surgery. The main point of ADAPT is to send the thrombus aspiration catheter to the thrombus, and then remove the thrombus by suction. If direct aspiration fails to recanalize the vessel, the catheter is used for SR thrombectomy. The advancement of thrombus aspiration catheter technology is mainly to improve the transportability and increase the inner diameters of the distal and proximal ends of the catheter in contact with the thrombus to increase the suction force.
In the experiment on 510 patients, the successful recanalization rate of the first suction was 61.8%, and the success rate of those who only used suction was 77.5%. The average operation time was 27.4 minutes, and the 90-day good prognosis (mRS 0-2) rate was 42.9%. Compared with the small diameter catheter (5MAX and ACE, P<0.05), the recanalization rate (suction only) of the larger diameter thrombus aspiration catheter was significantly higher, and the operation time was significantly reduced.
Therefore, the use of a reperfusion thrombus aspiration catheter with a larger inner diameter and stronger suction power improves the technique of ADAPT thrombectomy, improves patient prognosis, shortens operation time, and reduces the possibility of using other thrombus removal devices without increasing complications.