Open AccessMechanical Thrombectomy of Carotid Terminus Occlusion Using Direct Aspiration Technique—Video Illustration: 2-Dimensional Operative Video
Author(s) -
Sami Al Kasab,
Mithun G. Sattur,
Guilherme Porto,
Alejandro M Spiotta,
Adam S Arthur,
Mark Bain,
Bernard Bendock,
Mandy J. Binning,
Alan S. Boulos,
Webster Crowley,
Richard D. Fessler,
Andrew Grande,
Lee R. Guterman,
Ricardó A. Hanel,
Daniel Hoit,
L. Nelson Hopkins,
Jay U. Howington,
Robert F. James,
Brian T. Jankowitz,
Peter Kan,
A Khalessi,
Louis J. Kim,
David Langer,
Giuseppe Lanzino,
Michael R. Levitt,
Elad I. Levy,
Demetrius K. Lopes,
William J. Mack,
Robert A. Mericle,
J Mocco,
C Ogilvy,
Aditya S. Pandey,
Robert E. Replogle,
Howard A. Riina,
Andrew J. Ringer,
Rafael Rodríguez,
Eric Saugaveau,
Clemens M. Schirmer,
Adnan H. Siddiqui,
Ali Sultan,
Rabih G. Tawk,
Ajith J. Thomas,
Raymond D Turner,
Erol Veznedaroglu,
Babu G. Welch,
Jonathan White
Publication year - 2021
Publication title -
operative neurosurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 21
eISSN - 2332-4260
pISSN - 2332-4252
DOI - 10.1093/ons/opab272
Subject(s) - medicine , occlusion , internal carotid artery , circle of willis , posterior communicating artery , stroke (engine) , anterior communicating artery , cardiology , surgery , radiology , aneurysm , mechanical engineering , engineering
Acute carotid terminus occlusion (CTO) is responsible for up to 5% of acute ischemic strokes secondary to emergent large vessel occlusion (ELVO) and up to 20% of acute internal carotid artery (ICA) occlusions.1 The term "CTO" has also been used to describe occlusions in the supra-clinoid segment or at the bifurcation of the ICA. Compared to other ELVOs, patients with CTO present with higher stroke severity and larger infarct volume, likely to be a result of disruption of direct Circle of Willis collaterals across the anterior communicating artery (AComA) and posterior communicating artery (PComA).2,3 Similary, CTO is usually associated with worse prognosis compared to other ELVOs in general. With regard to response to treatment, previous studies have reported significantly lower recanalization rates with intravenous alteplase with CTO compared to M1 segment occlusion. With regard to the safety and efficacy of mechanical thrombectomy, prior reports provide conflicting results with some reporting lower successful recanalization rates with CTO compared to M1 occlusion, and others reporting similar results. In our experience, we have found that successful recanalization of CTO can be achieved with a similar approach to M1 occlusions utilizing a direct aspiration first pass technique (ADAPT).3,4 Herein, we present a case of CTO for which we performed mechanical thrombectomy using ADAPT. This procedure was an emergent standard of care procedure for which a consent was not required and so not obtained.