However, it is important to note that stent retrievers are associated with higher rates of endothelial injury, which may lead to neointimal hyperplasia and subsequent in-stent restenosis. Additionally, stent retrievers tend to be more challenging to use in tortuous vessels, such as the distal anterior cerebral artery and posterior circulation. Moreover, stent retrievers require a large-bore access catheter, which may not be feasible in patients with small or tortuous femoral arteries. Poor results may also come from the clot composition, location, and age.

On the other hand, aspiration catheters tend to be gentler on the vessel wall and have a lower risk of causing endothelial injury or dissection. They can also be used in tortuous vessels and are generally more straightforward to use, particularly in vessels that are difficult to access with a stent retriever. The implementation of ADAPT (aspiration-first, then stent retriever) protocols have shown promising results and are being investigated in clinical trials.