O23 Mechanical thrombectomy using a modified ADAPT (a direct aspiration first pass technique) in a patient with m1-occlusion and concomitant mca-aneurysm

We present a case in which a patient with a right-sided MCA M1 occlusion (NIHSS 30) and concomitant mediabifurcation aneurysm was fully recanalized (TICI 3) using a modified ADAPT technique, without prior passage of the thrombus as previously described by Turc et al.2. To us, the avoidance of blind aneurysm passage by microwire and microcatheter appears to be a major advantage of the method used. Instead, the aspiration catheter was advanced via a 0.035 Terumo guide wire for proximal stabilization. Thrombus was aspirated with proximally inflated BGC and repeated imaging series up to visualization of the aneurysm neck. Thus, blind probing of the mediabifurcation including the aneurysm was avoided and even residual thrombus adjacent to the aneurysm neck was removed. The patient benefited significantly with an improvement in NIHSS from 30 to 8 during his hospital stay. We conclude that this technique represents an interesting and potentially useful method for mechanical recanalization in the presence of a concomitant aneurysm of the carrier vessel. To what extent (modified) ADAPT is superior to other methods of mechanical recanalization in this constellation should be investigated in multicenter (e.g. registry) studies.ReferencesZibold F, Kleine JF, Zimmer C, Poppert H, Boeckh-Behrens T. Aneurysms in the target vessels of stroke patients subjected to mechanical thrombectomy: prevalence and impact on treatment. J Neurointerv Surg. 2016 Oct;8(10):1016–20. doi: 10.1136/neurin...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: 14th Congress of the European Society of Minimally Invasive Neurological Therapy 2022 Meeting Abstracts Source Type: research