Machine learning identifies subgroups where aspiration thrombectomy yields greater first-pass success than stent retrievers

In 6700 stroke patients, direct aspiration first-pass thrombectomy (ADAPT) achieved higher first-pass effect without symptomatic hemorrhage than stent retriever (39.9% vs 26.9%; aOR 2.07). ML identified subgroups with greater benefit: recent years, M1 occlusions, earlier time wi…

• Causal forest model revealed significant treatment effect heterogeneity (interaction P<0.001), with ADAPT particularly advantageous in recent years, M1 occlusions, and earlier time windows.
• In low-CATE patients, no difference between techniques (aOR 0.91, 95% CI 0.57-1.45); in high-CATE patients, ADAPT strongly favored (aOR 2.99, 95% CI 2.24-3.98).

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