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

Neuroradiol J. 2015 Dec;28(6):617-22. doi: 10.1177/1971400915609352. Epub 2015 Oct 6.


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.

Keywords: ADAPT; Thrombectomy; acute stroke; embolectomy; interventional neuroradiology; reperfusion.

Publication types

  • Case Reports

MeSH terms

  • 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