Outcomes Following First-Pass Direct Aspiration Versus Stent Retriever for Endovascular Thrombectomy in Primary Medium or Distal Vessel Occlusion: An Analysis of the SVIN Registry
14 affiliations
- 1Department of Neurosurgery, Mount Sinai Health System, New York, NY (S. Matsoukas, A.M., J.T.F., J.M., S. Majidi).
- 2Department of Neurology, UT Health McGovern Medical School, Houston, TX (S.A.S., A.I., J.N.S.).
- 3Department of Neurology, Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, GA (D.C.H., J.D., J.A.G., M.H.M.).
- 4Department of Neuroscience, Valley Baptist Medical Center-Harlingen, TX (A.E.H., W.G.T., S.M., H.M.S.).
- 5Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City (S.O.-G., M.G.-C., J.C., L.C.-C.).
- 6Department of Neurology, Cooper Neurological Institute, Cooper University Health Care, Camden, NJ (M.J.D., L.Z., J.K.).
- 7Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (M.A., P.K.).
- 8Department of Neurosurgery, Baptist Health Miami Neuroscience Institute, FL (G.D., I.L.).
- 9Memorial Neuroscience Institute, Pembroke Pines, FL (B.P.M., J. Sessa).
- 10Department of Neurology, ProMedica Toledo Hospital, OH (M.A.J.).
- 11Department of Neurology, University of South Alabama, Mobile (T.N.).
- 12Department of Neurology, Souers Stroke Institute, Saint Louis University School of Medicine, MO (G.L.).
- 13Department of Neurology and Neurosurgery, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, PA (A.R.A.-B., R.G.N.).
- 14Department of Neurology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles (D.S.L.).
Abstract
Background
Endovascular thrombectomy is increasingly performed for acute ischemic stroke due to medium vessel occlusion (MeVO); however, recent randomized trials-primarily using stent retriever (SR) techniques-have not demonstrated a clear benefit over medical management. This study aimed to compare the direct aspiration first-pass technique (ADAPT) and SR in MeVO using a multicenter endovascular thrombectomy consortium.Methods
The Society of Vascular and Interventional Neurology registry was queried for all primary MeVO cases treated with ADAPT or SR as the first-pass technique. MeVO was defined as an occlusion of A1, P1, M2, or beyond. Outcomes included time to recanalization, recanalization rates, first-pass effect (defined as Treatment in Cerebral Infarction-3 after first pass), intracranial hemorrhage, symptomatic intracranial hemorrhage, and clinical outcomes.Results
A total of 1391 patients with MeVO were identified; 415 (29.8%) in the ADAPT group and 976 (70.2%) in the SR group. The most common location of occlusion was the middle cerebral artery-M2 (75.9%), followed by the middle cerebral artery-M3 (11.4%). The median age was 70, and 698 (50.4%) patients were men. Time from angio-suite arrival to expanded Treatment in Cerebral Infarction (eTICI) ≥2b (54 versus 60, P=0.002), time from endovascular access to final recanalization (42 versus 52, P<0.001), time from endovascular access to eTICI 2b (31 versus 39, P<0.001), and eTICI 3 (26 versus 34, P<0.001) were shorter for the ADAPT group. Conversely, the SR group had higher rates of eTICI ≥2b (91.6% versus 86.3%, P=0.002) and first-pass effect (31.7% versus 23.4%, P=0.002). Rates of good outcome, excellent outcome, intracranial hemorrhage, and sICH were not significantly different between groups.Conclusions
Although ADAPT yielded faster recanalization, SR achieved a higher first-pass effect and slightly higher recanalization rates. Intracranial hemorrhage, symptomatic intracranial hemorrhage, and clinical outcomes were comparable between groups. This study suggests that both techniques may offer distinct advantages. Prospective randomized controlled studies are warranted to further understand the safety and efficacy of ADAPT versus the SR technique in patients with MeVO.
Related
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- Adjunctive Cerebrolysin therapy following mechanical thrombectomy for tandem right internal carotid artery and middle cerebral artery occlusion with residual post-procedural perfusion deficit: a case report
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BibTeX
@article{matsoukas2026outcomes,
title = {{Outcomes Following First-Pass Direct Aspiration Versus Stent Retriever for Endovascular Thrombectomy in Primary Medium or Distal Vessel Occlusion: An Analysis of the SVIN Registry}},
author = {Stavros Matsoukas and Amol Mehta and Johanna T Fifi and J Mocco and Sunil A Sheth and Ananya Iyyangar and Joseph Naji Samaha and Diogo C Haussen and Jaydevsinh Dolia and Jonathan A Grossberg and Mahmoud H Mohammaden and Ameer E Hassan and Wondwossen G Tekle and Samantha Miller and Hamzah M Saei and Santiago Ortega-Gutierrez and Milagros Galecio-Castillo and Jorge Cespedes and Leonardo Cruz-Criollo and Michael J Dubinski and Linda Zhang and Jane Khalife and Mohamad Abdalkader and Piers Klein and Guilherme Dabus and Italo Linfante and Brijesh P Mehta and Joy Sessa and Mouhammad A Jumma and Taha Nisar and Guillermo Linares and Alhamza R Al-Bayati and Raul G Nogueira and David S Liebeskind and Shahram Majidi},
journal = {Stroke (Hoboken, N.J.)},
year = {2026},
month = sep,
doi = {10.1161/svin.125.001950},
url = {https://europepmc.org/article/PMC/PMC13727254},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Outcomes Following First-Pass Direct Aspiration Versus Stent Retriever for Endovascular Thrombectomy in Primary Medium or Distal Vessel Occlusion: An Analysis of the SVIN Registry
AU - Stavros Matsoukas
AU - Amol Mehta
AU - Johanna T Fifi
AU - J Mocco
AU - Sunil A Sheth
AU - Ananya Iyyangar
AU - Joseph Naji Samaha
AU - Diogo C Haussen
AU - Jaydevsinh Dolia
AU - Jonathan A Grossberg
AU - Mahmoud H Mohammaden
AU - Ameer E Hassan
AU - Wondwossen G Tekle
AU - Samantha Miller
AU - Hamzah M Saei
AU - Santiago Ortega-Gutierrez
AU - Milagros Galecio-Castillo
AU - Jorge Cespedes
AU - Leonardo Cruz-Criollo
AU - Michael J Dubinski
AU - Linda Zhang
AU - Jane Khalife
AU - Mohamad Abdalkader
AU - Piers Klein
AU - Guilherme Dabus
AU - Italo Linfante
AU - Brijesh P Mehta
AU - Joy Sessa
AU - Mouhammad A Jumma
AU - Taha Nisar
AU - Guillermo Linares
AU - Alhamza R Al-Bayati
AU - Raul G Nogueira
AU - David S Liebeskind
AU - Shahram Majidi
PY - 2026
DA - 2026/09/24
JO - Stroke (Hoboken, N.J.)
DO - 10.1161/svin.125.001950
UR - https://europepmc.org/article/PMC/PMC13727254
AB - Background Endovascular thrombectomy is increasingly performed for acute ischemic stroke due to medium vessel occlusion (MeVO); however, recent randomized trials-primarily using stent retriever (SR) techniques-have not demonstrated a clear benefit over medical management. This study aimed to compare the direct aspiration first-pass technique (ADAPT) and SR in MeVO using a multicenter endovascular thrombectomy consortium.Methods The Society of Vascular and Interventional Neurology registry was queried for all primary MeVO cases treated with ADAPT or SR as the first-pass technique. MeVO was defined as an occlusion of A1, P1, M2, or beyond. Outcomes included time to recanalization, recanalization rates, first-pass effect (defined as Treatment in Cerebral Infarction-3 after first pass), intracranial hemorrhage, symptomatic intracranial hemorrhage, and clinical outcomes.Results A total of 1391 patients with MeVO were identified; 415 (29.8%) in the ADAPT group and 976 (70.2%) in the SR group. The most common location of occlusion was the middle cerebral artery-M2 (75.9%), followed by the middle cerebral artery-M3 (11.4%). The median age was 70, and 698 (50.4%) patients were men. Time from angio-suite arrival to expanded Treatment in Cerebral Infarction (eTICI) ≥2b (54 versus 60, P=0.002), time from endovascular access to final recanalization (42 versus 52, P<0.001), time from endovascular access to eTICI 2b (31 versus 39, P<0.001), and eTICI 3 (26 versus 34, P<0.001) were shorter for the ADAPT group. Conversely, the SR group had higher rates of eTICI ≥2b (91.6% versus 86.3%, P=0.002) and first-pass effect (31.7% versus 23.4%, P=0.002). Rates of good outcome, excellent outcome, intracranial hemorrhage, and sICH were not significantly different between groups.Conclusions Although ADAPT yielded faster recanalization, SR achieved a higher first-pass effect and slightly higher recanalization rates. Intracranial hemorrhage, symptomatic intracranial hemorrhage, and clinical outcomes were comparable between groups. This study suggests that both techniques may offer distinct advantages. Prospective randomized controlled studies are warranted to further understand the safety and efficacy of ADAPT versus the SR technique in patients with MeVO.
SN - 2694-5746
ER -