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1044 Optimizing Single-Pass Thrombectomy: Multicenter Comparative Analysis of Direct Aspiration versus Combined Aspiration and Stent Retriever Techniques in 1,070 Patients
Abstract   Peer reviewed

1044 Optimizing Single-Pass Thrombectomy: Multicenter Comparative Analysis of Direct Aspiration versus Combined Aspiration and Stent Retriever Techniques in 1,070 Patients

Santiago Gomez-Paz, Diwas Gautam, Jackson Aubrey, Matthew Findlay, Julian Brown, Michael T. Bounajem, Danielle C. Brown, Manisha Koneru, Anderson Brito, Leonardo Cruz-Criollo, …
Neurosurgery, Vol.72(Supplement_1), pp.187-188
04/2026
DOI: 10.1227/neu.0000000000003964_1044

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Abstract

INTRODUCTION: Achieving rapid and safe first-pass successful reperfusion (FPSR) during mechanical thrombectomy strongly influences stroke outcomes. Comparative real-world data evaluating direct aspiration thrombectomy (ADAPT) versus combined stent-retriever with aspiration (Solumbra), specifically in patients achieving FPSR, remain limited. Additionally, the modifying effect of aspiration catheter size on these techniques has not been well-defined. METHODS: We retrospectively analyzed 1,070 thrombectomies performed at three comprehensive stroke centers. Procedures were classified into ADAPT (n = 356) and combined aspiration-stent retriever (n = 714), noting large-bore catheter use separately. Primary outcome was rapid successful reperfusion (mTICI ≥ 2B within 30 min). Secondary outcomes included first-pass effect (FPE; mTICI 2C–3), modified first-pass effect (mFPE; mTICI ≥ 2B on first pass), symptomatic intracranial hemorrhage (sICH), and favorable functional outcomes (mRS ≤ 3). Multivariable logistic regression with interaction terms evaluated catheter size effects. RESULTS: Among 1,070 cases, mean patient age was 68 ± 15 years, with similar distributions of anterior circulation (94%) and large-vessel occlusions (75%). ADAPT achieved shorter puncture-to-reperfusion times (21 vs 39 min; p < 0.001), higher rapid reperfusion rates (71% vs 34%; p < 0.001), and fewer sICH events (10% vs 21%; p < 0.001). Among single-pass reperfusion successes (n = 456), ADAPT maintained its advantage in rapid reperfusion (83% vs 55%; p < 0.001) and safety (sICH: 6% vs 20%; p < 0.001). Multivariable analysis showed ADAPT with large-bore catheters had the highest odds for rapid reperfusion (aOR 4.79; 95% CI 2.17–10.59) and mFPE (aOR 3.90; 95% CI 1.64–9.31), and lowest sICH risk (aOR 0.14; 95% CI 0.04–0.48). CONCLUSIONS: Direct aspiration thrombectomy with large-bore catheters significantly improved procedural speed, efficacy, and safety compared to combined techniques. These findings support ADAPT with large-bore catheters as the preferred strategy to optimize first-pass success in mechanical thrombectomy.

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