Abstract 184: ADAPT Using a Modified Biaxial System With a 0.035” Guidewire for Aspiration Catheter Delivery: a single center experience
Authors: Shah R. , Cuellar H. , Chokhawala H. , Savardekar A. , Sharma P. , Thapa M. , Oderhowho A. 
Published: January 2025

Introduction
A Direct Aspiration first Pass Technique (ADAPT) has established its place as the technique of choice for thrombectomies over the last few years. Recently there has been a move towards novel devices that facilitate a biaxial system for ADAPT thrombectomy. These systems use of a large bore catheter and a delivery device, rather than a conventional triaxial set‐up featuring an intermediate catheter. We present our institutional experience with a biaxial modification of the ADAPT technique using only the Colossus 0.035” OD guidewire in place of the triaxial microcatheter‐microwire system traditionally used for thrombectomies. We postulate that this modification is safe, effective and offers significant cost benefits over the traditional method.

Methods
We performed a retrospective review of our institutional stroke database over an eleven‐month period and pulled the data for all the thrombectomies using the 0.035” guidewire as a biaxial system to replace a microcatheter‐microwire combination in the modified of the ADAPT technique. We included no other inclusion criteria, to ensure our results reflected real‐world patient results regardless of co‐morbidity, age, or disease state characteristics. All relevant patient clinical and demographic data were collected, as well as procedural details, reperfusion rates, complications and overall outcomes data.

Results
A total of 50 consecutive patients underwent thrombectomy using the modified technique and met all inclusion criteria. Mean age was 68.2 years; 33 females and 17 males, with occlusions in M1 (35 cases), M2 (12 cases), and basilar arteries (2 cases). All 50 patients achieved successful delivery of aspiration catheter with the Colossus wire. 37 patients (74.0%) had Thrombolysis In Cerebral Infarction (TICI) 2C or 3 reperfusion with 48 (96.0%) patients achieving TICI>=2B reperfusion. Two patients achieved no reperfusion. First‐pass reperfusion was achieved in 27/50 patients. Eight patients needed four or more attempts. Eleven patients required stent‐retriever in addition to aspiration for achieving recanalization. Six patients were found to have severe ICA stenosis requiring angioplasty to get the aspiration catheter across to distal site of occlusion and subsequent ICA stent placement. Mean time to reperfusion was 30.2 mins for all cases. Mean time to access (calculated as puncture to time of first pass) was 20.0 mins. No immediate vascular or procedural complications attributable to the devices used occurred.

Conclusion
Based on our institutional experience, the modified ADAPT technique of creating a biaxial system by replacing the microcatheter + microwire combination with a 0.035” Colossus guidewire for mechanical thrombectomy is a safe and effective technique. We achieved 100% success in delivering the aspiration catheter to the clot interface using the guidewire alone. Using a biaxial system for thrombectomy rather than the traditional triaxial system for ADAPT showed significant cost‐savings at our center, as well as potentially decreasing prep time.