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Mechanical thrombectomy for large vessel occlusion presenting with acute ischemic stroke is evidently in its Tower of Babel stage, inundated with increasing numbers of acronym-focused techniques all claiming ‘improved’ revascularization.1–5 The overarching term ‘mechanical thrombectomy’ is grossly inaccurate in the vast majority of cases for we are removing an embolus—a procedure better called ‘embolectomy.’ The race for new acronyms to describe procedures, however, can be traced back to the currently most popular, ADAPT. A Direct Aspiration first Pass Technique (ADAPT)6 7 is a well-established method with demonstrated efficacy through multiple prospective randomized trials, but we remain confused about the ‘exact’ procedure. Can anyone tell us, after engaging the clot, should we expect the clot to be ingested or not, and, if not, what we should do next? Do we pull slowly? How long should we wait before pulling back? Do we touch or embed the aspiration catheter in the clot? Do we aspirate manually? How far do we pull back? Is it usual to achieve full clot ingestion, or is it more common to ‘cork’ the clot and subsequently retrieve it, hanging in the breeze, as we pull into the guide? And let’s not even start discussing …
Contributors All authors contributed to the conception, drafting, revisions, and approval of this editorial. DFK is the guarantor of this work.
Funding SAA: (unrelated) NIH/NINDS and NHLBI research funding; DFK: research support from Medtronic, MicroVention, NeuroSigma, Shape Memory Therapeutics, IndumedX, Sequent Medical, NeuroSave; DSL: consultant to Medtronic and Stryker as imaging core laboratory.
Competing interests SAA: medical director, Neurovascular Quality Initiative (NVQI), Society of Neurointerventional Surgery (SNIS); SAA, DSL, AHS: co-chairs, Coordinated Registry Network (CRN)-Devices Used for Acute Ischemic Stroke Intervention (DAISI) Governing Council; DFK: consulting for Medtronic (all funds to the institution), ownership stake in Marblehead Medical, LLC, research support MicroVention, advisory board Triticum, Inc. DFK is an Advisory Board Member for Boston Scientific.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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