Modified BADDASS technique for acute anterior circulation large vessel occlusion: A single-centre, randomized controlled trial.

Abstract

To test whether the modified BADDASS technique improves clinical outcomes compared with the standard technique in patients with acute anterior circulation large vessel occlusion (AAC-LVO). This single-center, prospective, randomized controlled trial was conducted at Zhangjiagang Hospital Affiliated to Soochow University from July 2023 to October 2025. Patients with AAC-LVO presenting within 24 hours of symptom onset were randomized to receive either the modified BADDASS technique (Embotrap III thrombectomy stents and the partial retrieval of the stent with an aspiration catheter) or the standard BADDASS technique. The primary outcome was functional independence at 90 days (modified Rankin Scale score 0-2). A total of 170 patients (median age: 71 years) were enrolled. The modified technique did not significantly improve the primary outcome versus the standard technique (56% vs. 51%, adjusted risk ratio [aRR]: 1.14 [95% CI: 0.85-1.53]; P = 0.40). For secondary outcomes, the modified technique was associated with higher rates of modified first-pass effect (mFPE) (76% vs. 61%, aRR:1.23 [95%CI:0.85, 1.77]; P=0.04) and FPE (55% vs. 39%, aRR:1.44[95%CI:1.03,2.00]; P=0.03]. No significant differences were observed in successful reperfusion (91% vs. 93%, aRR:0.97 [95%CI:0.71,1.33]; P=0.85), symptomatic intracranial hemorrhage (15% vs. 16%, aRR:0.86 [95%CI:0.39,1.90]; P=0.71]) or mortality (7% vs. 12%, aRR:0.43 [95%CI:0.13,1.43]; P=0.17). Contrary to our hypothesis, the modified BADDASS technique did not improve 90-day functional outcomes versus the standard technique in AAC-LVO. Despite higher FPE and mFPE rates, these procedural advantages did not translate into clinical benefit. Larger studies are needed to determine whether specific subgroups may derive benefit.