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Mechanical Thrombectomy of Carotid Terminus Occlusion Using Direct Aspiration Technique—Video Illustration: 2-Dimensional Operative Video

医学 闭塞 颈内动脉 威利斯圆 后交通动脉 冲程(发动机) 前交通动脉 心脏病学 外科 内科学 放射科 动脉瘤 机械工程 工程类
作者
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 W. Grande,Lee R. Guterman,Ricardó A. Hanel,Daniel Hoit,L. Nelson Hopkins,Jay U. Howington,Robert F. James,Brian T. Jankowitz,Peter Kan,Alex A Khalessi,Louis J. Kim,David J. Langer,Giuseppe Lanzino,Michael R. Levitt,Elad I. Levy,Demetrius K. Lopes,William J. Mack,Robert A. Mericle,J Mocco,Chris Ogilvy,Aditya S. Pandey,Robert Replogle,Howard A. Riina,Andrew J. Ringer,Rafael Rodríguez,Eric Saugaveau,Clemens M. Schirmer,Adnan H. Siddiqui,Alex Spiotta,Ali Sultan,Rabih G. Tawk,Ajith J. Thomas,Raymond D Turner,Erol Veznedaroglu,Babu G. Welch,Jonathan White
出处
期刊:Operative Neurosurgery [Lippincott Williams & Wilkins]
卷期号:21 (5): E441-E442
标识
DOI:10.1093/ons/opab272
摘要

Abstract 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.
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