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A direct aspiration first-pass technique (ADAPT) versus stent retriever for acute ischemic stroke (AIS): a systematic review and meta-analysis

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Abstract

Background and purpose

There is an ongoing debate about whether a direct aspiration first-pass technique (ADAPT) or stent retriever should be used as the first-pass mechanical thrombectomy device for patients with acute ischemic stroke (AIS). This meta-analysis aimed to compare the safety and efficacy of ADAPT versus stent retriever in patients with AIS.

Methods

Structured searches on the PubMed, Embase, and Cochrane Library databases were conducted through July 2020. The primary outcomes of this study were: successful and complete recanalization; excellent and favorable outcomes; all-cause mortality at 90 days; and symptomatic intracerebral hemorrhage (sICH). The secondary outcomes of this study were: successful recanalization by primary chosen device; additional therapy; occurrence of emboli in a new territory; hemorrhagic complication; hemorrhagic infarction; parenchymatous hematoma; and subarachnoid hemorrhage. The odds ratios (ORs) with 95% confidence intervals (CIs) of the primary and secondary outcomes were calculated using a random-effects model. I2 statistics were used to assess the heterogeneity for each outcome among the included studies.

Results

Finally, 20 studies with a total of 6311 patients were included in our meta-analysis. There were no significant differences between the ADAPT group and the stent retriever group of the primary and secondary outcomes except additional therapy. Our pooled results indicated that patients in the ADAPT group needed more additional therapy than those in the stent retriever group (OR 2.24, 95% CI 1.41–3.57).

Conclusion

In conclusion, our meta-analysis showed similar clinical outcomes of ADAPT and stent retriever. However, patients in the ADAPT group had higher additional therapy rates than those in the stent retriever group. Due to several inevitable limitations of this meta-analysis, more large-scale randomized controlled trials are required to further investigate this topic.

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Authors and Affiliations

  1. Department of Psychiatry, The Second Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China

    Yichi Zhang & Wenqiang Li

  2. Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China

    Yue Zhang, Chentao Hu & Weisong Zhao

  3. Department of Psychiatry, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453000, Henan, China

    Zhaohui Zhang

  4. Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, No. 388 Jianshe Road, Xinxiang, 453000, Henan, China

    Yichi Zhang & Wenqiang Li

  5. Henan Key Lab of Biological Psychiatry, International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang Medical University, Xinxiang, 453000, Henan, China

    Wenqiang Li

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YZ, YZ, and CH: study search and data extraction. YZ and YZ: data analysis, drafting and revising the manuscript. YZ and CH: quality assessment. CH: making tables and figures. WZ: direction and assistance during the meta-analysis process. ZZ: revision of the meta-analysis. WL: supervision of the meta-analysis and critical revision of the manuscript.

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Zhang, Y., Zhang, Y., Hu, C. et al. A direct aspiration first-pass technique (ADAPT) versus stent retriever for acute ischemic stroke (AIS): a systematic review and meta-analysis. J Neurol 268, 4594–4606 (2021). https://doi.org/10.1007/s00415-020-10284-w

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