title: 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.
  
  
  METHODS
  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.affiliation: Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain ccastanod@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Castaño
authors.affiliation: Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Remollo
authors.affiliation: Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: García
authors.affiliation: Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Hidalgo
authors.affiliation: Acute Stroke Unit, Service of Neurology, Department of Neurosciences, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona.
authors.forename: Maria
authors.initials: M
authors.lastname: Hernández-Perez
authors.affiliation: Department of Anesthesiology, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Ciorba
mesh_terms: D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D009186:Myelin Sheath / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods*; D015641:Radiography, Interventional; D015607:Stents; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D018084:Ultrasonography, Interventional
keywords: ADAPT; Thrombectomy; acute stroke; embolectomy; interventional neuroradiology; reperfusion