Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
J Neurointerv Surg. 2020 Nov;12(11):1148. doi: 10.1136/neurintsurg-2020-016131. Epub 2020 Jun 23.
The impact of ADAPT-"a direct aspiration first pass technique"-on intracranial vasculature is not well understood, since the change of arterial diameter is often not visible during aspiration. We present a unique case in which the impact of aspiration on the parent vessel was visualized due to a previously deployed Neuroform Atlas stent and a Pipeline embolization device. The patient presented with right internal carotid artery occlusion. An aspiration catheter was advanced over the microcatheter system and corked into the clot, located within the stents in proximal M1. The stents were seen to collapse both during electronic pump and hand aspiration with no evidence of stent migration. This demonstrates that it is crucial to engage the clot interface with the tip of the aspiration catheter while performing ADAPT. Placing the aspiration catheter remote from the clot may result in collapse of the artery proximal to the clot with subsequent ADAPT failure.(video 1) neurintsurg;12/11/1148/V1F1V1video 1.
ADAPT（直接抽吸首过技术）对颅内血管的影响尚不清楚，因为在抽吸过程中动脉直径的变化通常不可见。我们呈现了一个独特的病例，由于先前放置的 Neuroform Atlas 支架和 Pipeline 栓塞装置，抽吸对母血管的影响可见。患者表现为右侧颈内动脉闭塞。抽吸导管在微导管系统内推进，并堵塞在位于近端 M1 内支架内的血栓中。支架在电子泵和手动抽吸过程中均可见塌陷，无支架移位的证据。这表明，在进行 ADAPT 时，用抽吸导管尖端与血栓界面接触至关重要。如果将抽吸导管放置在远离血栓的位置，可能会导致血栓近端动脉塌陷，随后 ADAPT 失败。（视频 1）
