Mechanical thrombectomy with 'ADAPT' technique by transcervical access in acute ischemic stroke.

Abstract

BACKGROUND:

The mechanical thrombectomy (MT) for endovascular clot retrieval has dramatically improved successful revascularization and clinical outcome in selected acute stroke patients. MT is typically performed via a transfemoral approach, but catheterization of the occluded vessel can be problematic in cases of extensive vessel tortuosity. We describe a case of MT with the 'ADAPT' technique by direct carotid access due to an inability to catheterize the ICA by a transfemoral approach for acute cerebral ischemia in the setting of left MCA occlusion. Excellent angiographic and good clinical results were obtained without any complications.

CASE REPORT:

An 80-year-old woman was admitted with a stroke by occlusion of the left MCA, with an NIHSS: 11, and an ASPECT: 7 in the CT. Under sedation a transfemoral angiography was performed, but after multiple attempts, it was impossible to make a stable catheterization of the left CCA. A transcervical approach was pursued. With ultrasound guidance the CCA was catheterized. Using the 'ADAPT' technique, we performed a successful MT. Post-procedure angiography (at 14 minutes) demonstrated recanalization of the entire left MCA (TICI: 3), without complications. The carotid access point was closed with a percutaneous closure. Control TC at 24 h showed a slight hypodensity in the left lenticular nucleus, and loss of gray-white matter differentiation in the adjacent cortex. Neurologically, the patient presented with progressive improvement. At discharge, she had an NIHSS: 0, mRS: 0 and Barthel: 100.

CONCLUSIONS:

MT by direct carotid access is an effective alternative technique in those cases where it is not accessible by a transfemoral approach.

• Authors: Carlos Castaño, Sebastian Remollo, Maria Rosa García, Cristina Hidalgo, Maria Hernández-Perez, Mihaela Ciorba
• Journal: The neuroradiology journal (Neuroradiol J) Vol. 28 Issue 6 Pg. 617-22 (Dec 2015) ISSN: 1971-4009 [Print] United States
• PMID: 26443297 (Publication Type: Case Reports, Journal Article)
• Copyright: © The Author(s) 2015.

Topics

• Aged, 80 and over
• Brain Ischemia (surgery)
• Carotid Artery, Internal (surgery)
• Cerebral Angiography
• Female
• Humans
• Myelin Sheath (pathology)
• Neurosurgical Procedures (methods)
• Radiography, Interventional
• Stents
• Stroke (surgery)
• Thrombectomy (methods)
• Ultrasonography, Interventional