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

Sami Al Kasab, Mithun Sattur, Guilherme Porto, Alejandro M. Spiotta, Adam Arthur, Mark Bain, Bernard Bendock, Mandy Jo Binning, Alan S. Boulos, Webster Crowley, Richard Fessler, Andrew Grande, Lee Guterman, Ricardo Hanel, Daniel Hoit, L. Nelson Hopkins, Jay Howington, Robert James, Brian Jankowitz, Peter KanAlex A. Khalessi, Louis Kim, David Langer, Giuseppe Lanzino, Michael Levitt, Elad I. Levy, Demetrius Lopes, William Mack, Robert Mericle, J. Mocco, Chris Ogilvy, Aditya Pandey, Robert Replogle, Howard Riina, Andrew Ringer, Rafael Rodriguez, Eric Saugaveau, Clemens Schirmer, Adnan H. Siddiqui, Alex Spiotta, Ali Sultan, Rabih Tawk, Ajith Thomas, Raymond Turner, Erol Veznedaroglu, Babu Welch, Jonathan White

Research output: Contribution to journalArticlepeer-review


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 supraclinoid 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 withworse 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.

Original languageEnglish (US)
Pages (from-to)E441-E442
JournalOperative Neurosurgery
Issue number5
StatePublished - Nov 1 2021
Externally publishedYes


  • Acute stroke
  • Carotid terminus
  • Mechanical thrombectomy
  • Occlusion

ASJC Scopus subject areas

  • General Medicine


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