{
  "abstract": "Introduction/Purpose Mechanical thrombectomy techniques have undergone rapid evolution since the first positive randomized controlled trials. ASCENT (ASpiration Clot Extraction Navigated by Tenzing) is a modification of contact aspiration that uses an inner tapered delivery device to advance an aspiration catheter directly to the site of occlusion without crossing it with a wire or catheter. This approach also facilitates delivery of larger bore catheters better matched to the target vessel diameter, which is a known driver of recanalization success. This investigation seeks to compare recanalization outcomes and procedural safety of ASCENT compared to thrombectomy with stentriever or ADAPT in an institutional series.Materials and Methods A retrospective review of consecutive mechanical thrombectomy cases performed across two high-volume regional stroke centers from January 2022 through December 2025 was conducted according to IRB protocol. All patients, operators, and devices were included without exclusion. Technique was classified as stentriever, ADAPT, or ASCENT per published definitions and device instructions for use. Aspiration cases utilizing an inner catheter but technique different from the original ADAPT technique were classified as modified ADAPT (mADAPT). Any pass utilizing a stentriever was included in that group; passes that did not clearly fit according to definitions or instructions were not assigned to a technique group. Primary outcome was recanalization score according to eTICI score. Secondary outcomes included first pass effect (FPE, TICI 2b-3), modified FPE (mFPE, TICI 2c-3), eTICI2b-3, eTICI 2c-3, secondary occlusion, and procedural complications. Fisher’s exact test was used for univariable analysis; multivariable logistic regression was performed to identify independent associations and adjust for potential confounders among other predictor variables, including occlusion location, device selection, tandem disease, intrinsic ICAD, and lytic status. Other than evaluation of FPE, analysis was performed on a per-pass basis.Results A total of 684 occlusions in 664 consecutive patients were identified, treated with a total of 1,219 thrombectomy passes. Technique distribution were as follows—stentriever 96 (8.0%), ADAPT 181 (15.2%), mADAPT 206 (16.9%) and ASCENT 736 (62.8%). ASCENT demonstrated significantly superior FPE at 71.0% compared to stentriever 43.8%, ADAPT 21.5%, and mADAPT 38.6% (p<0.0001). mFPE was similarly superior with ASCENT at 59.3% versus stentriever 31.3%, ADAPT 18.5%, and mADAPT 36.4% (p<0.0001). On multivariable analysis, ASCENT was the sole independent predictor of improved eTICI, eTICI 2b-3, and TICI 2c-3 (all p<0.0001), with no significant contributions from occlusion location, lytic status, or tandem disease. Secondary occlusion was more frequent with ADAPT (p=0.009) and inversely associated with ASCENT (p<0.0001). Intracranial complications were more common with ADAPT (p=0.023) and with crossing the occlusion using the inner device (p=0.023). Vessel injury requiring sacrifice occurred in one stentriever case and one ADAPT case. Four wire perforations and 5 intracranial dissections occurred. No ASCENT cases required vessel sacrifice.Conclusion ASCENT demonstrates superior recanalization performance and a more favorable safety profile compared to stentriever thrombectomy and ADAPT. The ability to deliver aspiration catheters matched to vessel diameter without crossing the thrombus likely mitigates clot fragmentation and distal migration, the principal drivers of secondary occlusion and failed recanalization seen with competing approaches.Disclosures M. Alexander: 2; C; Route 92 Medical, Stryker, J&J, Medtronic. 4; C; Certus Critical Care, Route 92 Medical, Piraeus Medical, Galaxy Therapeutics. B. Varjavand: None. T.A. Chaudhry: None. F. Settecase: 1; C; Terumo. 2; C; Route 92 Medical, Stryker Neurovascular, Medtronic. 4; C; Route 92 Medical. J. English: 2; C; Stryker Neurovascular. 4; C; Route 92 Medical. 5; C; Route 92 Medical. W. Kim: 2; C; Route 92 Medical, Stryker Neurovascular. 4; C; Route 92 Medical. R. Khangura: None.",
  "authors": [
    {
      "affiliations": [
        "NeuroInterventional Radiology, Sutter Medical Group, Sacramento, CA"
      ],
      "name": "M Alexander"
    },
    {
      "affiliations": [
        "Sutter Medical Group, Sacramento, CA"
      ],
      "name": "B Varjavand"
    },
    {
      "affiliations": [
        "NeuroInterventional Radiology, Sutter Medical Group, Sacramento, CA"
      ],
      "name": "TA Chaudhry"
    },
    {
      "affiliations": [
        "California Pacific Medical Center, San Francisco, CA"
      ],
      "name": "F Settecase"
    },
    {
      "affiliations": [
        "NeuroInterventional Surgery, California Pacific Medical Center, San Francisco, CA"
      ],
      "name": "J English"
    },
    {
      "affiliations": [
        "NeuroInterventional Surgery, California Pacific Medical Center, San Francisco, CA"
      ],
      "name": "W Kim"
    },
    {
      "affiliations": [
        "Sutter Medical Group, Sacramento, CA"
      ],
      "name": "R Khangura"
    }
  ],
  "title": "E-112 ASCENT technique achieves superior recanalization and safety compared to stentriever thrombectomy and adapt",
  "uid": "067f821a-b740-5c5d-ae1a-6cc89189c71d"
}