Conversations with Dr. Will Ares on the novel AO-ADAPT technique for treating ischemic stroke

Dr. William Ares walks us through the highlights of a new study, “Aristotle®-Only Direct Aspiration First-Pass Technique (AO-ADAPT) for Endovascular Mechanical Thrombectomy: A Technical Series of a Novel Technique Demonstrating Safety and Efficacy” (W. Ares, S. Chowdhry, D. Tonetti, W. Salah, B. Jankowitz, R. Grandi) published in Stroke: Vascular and Interventional Neurology. The study was designed to investigate a novel technique (AO-ADAPT) where a standard ADAPT technique is used for revascularization, but the large-bore aspiration catheter is delivered to the target occlusion over an Aristotle® 24 guidewire without an intermediate microcatheter.

Results
With AO-ADAPT, direct catheter placement was achieved in 77.8% of procedures, bypassing the need for a microcatheter.
Data showed an impressive 93.3% success rate in vessel recanalization with a TICI 2B or better.
TICI 2B+ rate was an optimal 100% and TICI2C/3 occurred in 85% of patients with successful AO-ADAPT.
First pass reperfusion was realized in over half of patients, with a 57.8% success rate, demonstrating the efficacy of the technique right from the first attempt.
With AO-ADAPT, the average time to revascularization was reduced to 16.5 minutes, streamlining the process compared to traditional stentriever interventions.
Patient safety is a top priority — the study reported no intracranial vascular complications, underlining the safety profile of the Aristotle® guidewires.

The Performance of Aristotle® Macrowires
The similar size of an 0.024” macrowire to an 0.021” microcatheter (typically utilized in stroke thrombectomy) means similar support experienced with the guidewire alone; the larger size of the wire fills more of the inner lumen of the catheter, minimizing ledge effect; and the performance attributes of microfabrication can be seen in torquability as well as tip shape retention for better selection of bifurcations while traveling to the thrombectomy site. Lastly, a larger diameter translates to more surface area for force distribution, which can provide a softer interaction with the anatomy than that of smaller guidewires.

Where Next
The latest Aristotle® Colossus 0.035” macrowire is showing promise for more support and even more ledge mitigation. Enrollment is underway to further study the use of Aristotle® Colossus for the AO-ADAPT technique, and with initial findings promising an even better rate of delivery. This could mean more successful recanalization rates, improved patient outcomes, and enhanced cost savings by obfuscating the need for an intermediate catheter or other ancillary devices.