The ASCEND Technique-A Modified Direct Aspiration First Pass Technique for a Faster and Cost-effective Mechanical Thrombectomy.

Purpose: Direct aspiration first pass technique (ADAPT) has been the standard for aspiration thrombectomy (AT) in anterior circulation large vessel occlusion (AC-LVO) with modifications of the technique based on devices used and difficulties encountered. We introduce the ASCEND technique (Aspiration with Steam-shaped Catheter, Excluding additioNal Devices), and hypothesize that it improves catheter navigation, leading to time and cost savings in MT.

Methods: This is a single institute, retrospective, pre-post intervention study, including consecutive patients with AC-LVO who underwent AT as first-pass technique. Patients were divided into two groups based on the first-pass technique attempted (ASCEND vs conventional ADAPT). Baseline characteristics, primary outcomes (first pass time, total procedure time, total additional devices and device cost) and secondary outcomes (recanalization, complications) were compared between groups. Multiple linear regression models were built for primary outcomes to look for the effect of steam-shaping when covariates are present to reflect real-world setting. Multi-national survey performed to introduce the technique and feedback obtained.

Results: ASCEND (n = 39) and cADAPT (n = 40) groups were similar in baseline clinical characteristics. Anterior genu and ophthalmic segment were crossed in 94.9%, clot reached in 84.6%, and entire MT procedure completed in 59.0% of patients of the ASCEND group without use of additional materials. Groups were similar in performance and safety indicators. ASCEND technique was superior to conventional ADAPT with less first-pass time (8.9 vs 14.7 min), total procedure time (20.2 vs 35.4 min), additional devices used (0 vs 3) and cost involved (2083 vs 5830 £) per procedure (all P < 0.05). Multiple linear regression models maintained improved primary outcomes with steam-shaping (all P < 0.05). Neurointerventionalists who tried ASCEND (n = 11) affirmed that it was safe and likely to save time and cost involved.

Conclusion: ASCEND technique, involving a simple step of steam-shaping the aspiration catheter during MT can provide huge benefits in time and cost savings, without compromise of performance or safety.