Interest of Direct Aspiration First Pass Technique (ADAPT) for Thrombectomy Revascularisation of Large Vessel Occlusion in Acute Ischaemic Stroke

NCT ID: NCT02523261

Last Updated: 2026-01-22

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 381 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-10-10
• Study Completion Date: 2017-02-28

Brief Summary

Mechanical thrombectomy (TM) is now validated through 4 randomized controlled trials of high scientific level as the reference treatment of cerebral infarction associated with proximal cerebral occlusion (MR CLEAN, ESCAPE 2014, 2015). These studies have shown for the first time a major decrease (-35%) of disability related to severe cerebral infarction and reduction in mortality. These studies only used thrombectomy devices called stent retriever for obtaining recanalization rates ranging from 58-72% for the 2 largest studies (MR CLEAN, ESCAPE 2014, 2015). This criterion "recanalization" is important because it largely determines the functional prognosis of patients with severe cerebral infarction (Khatri, 2014).

These results are exciting but we can do even better. Indeed, already new thrombectomy devices are available with a special interest for ADAPT (A Direct Aspiration First Pass Technic). This distal suction system, with a high level of endovascular navigability, provides high recanalization rates (> 90%), low morbidity, with a synergistic effect with stent retriever (Turk A, Kowoll 2014 and 2015). To date, these technic (ADAPT) has never been assessed in a randomized controlled trial.

We have previously conducted a comparative observational study between two recanalization strategies by thrombectomy using first-line ADAPT or the most widely used stent retriever. The interventional neuroradiologist could, in case of recanalization failure with the Solitaire system, used another thrombectomy material left to the operator's choice. 244 consecutive patients on two centers (Rothschild Foundation, and Foch Hospital, France) admitted for a cerebral infarction associated with proximal occlusion were included. This is so far the largest series of patients with ADAPT system. The complete recanalization rate was 84% with ADAPT versus 68% with stent retriever (P = 0.006). Unpublished data, Oral presentation at the European Stroke Organization, April 2015). Our research aims to show that a first line strategy of recanalization by thrombectomy using a distal suction system (ADAPT) is superior that the use of a stent retriever.

Conditions

Ischemic Cerebrovascular Accident

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

ADAPT

Group Type: EXPERIMENTAL

direct aspiration procedure

Intervention Type: PROCEDURE

Revascularization by endovascular thrombectomy using the distal aspiration first pass technique

Stent Retriever

Group Type: ACTIVE_COMPARATOR

stent retriever procedure

Intervention Type: PROCEDURE

Revascularization by endovascular thrombectomy using a mechanical thrombectomy device

Interventions

direct aspiration procedure

Revascularization by endovascular thrombectomy using the distal aspiration first pass technique

Intervention Type: PROCEDURE

stent retriever procedure

Revascularization by endovascular thrombectomy using a mechanical thrombectomy device

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Age > 18 years with no upper age limit.
• Cerebral infarction in the anterior circulation
• Occlusion of the anterior circulation proven by CT angiography or MR angiography
• With or without previous Intravenous thrombolysis
• Start of thrombectomy procedure within 6 hours of symptoms onset.
• Patient expresses verbally his non-opposition to be enrolled in the study ; in case patient cannot communicate, verbal non-opposition is obtained from his close / trusted person

Exclusion Criteria

• Absence of indication for thrombectomy
• Cons-indication for thrombectomy
• Presence of cerebral infarction of the posterior circulation
• Occlusion of the cervical carotid artery
• Allergy to x-ray contrast products
• Patient was bedridden or using a wheelchair most of the day (pre-event modified Rankin Scale score > 3) prior to stroke
• Pregnancy or breastfeeding
• Patient under legal protection
• No affiliation to health insurance

• Lack of access route for catheterization

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Fondation Ophtalmologique Adolphe de Rothschild

NETWORK

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Michel PIOTIN

Role: PRINCIPAL_INVESTIGATOR

Fondation ophtalmologique de Rothschild

Locations

CHU Pellegrin

Bordeaux, , France

Hospices Civils de Lyon

Bron, , France

CHU Dupuytren

Limoges, , France

CHU Hôpital Gui de Chaulac

Montpellier, , France

Hôpital Neurologique

Nancy, , France

Hôpital Guillaume et René LAENNEC

Nantes, , France

Fondation Ophtalmologique Adolphe de Rothschild

Paris, , France

Hôpital Foch

Suresnes, , France

Countries

France

References

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Reference Type: DERIVED

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Reference Type: DERIVED

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Other Identifiers

MPN_2015_22

Identifier Type: -

Identifier Source: org_study_id