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)
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Contributors Conception and design: all authors. Data acquisition: all authors. Data analysis and interpretation: all authors. Drafting the abstract: MW. Preparing the video: RHD. Critically revising the abstract and video: all authors. Final approval: all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests RHD, MKT, MW, HHR, GBR: None. AHS: Financial interest/investor/stock options/ownership: Adona Medical, Inc, Amnis Therapeutics, (Purchased by Boston Scientific October 2017), Blink TBI Inc, Buffalo Technology Partners Inc, Cerebrotech Medical Systems, Inc, Cognition Medical, Endostream Medical Ltd, Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics Inc, Q’Apel Medical Inc, Rebound Therapeutics Corp, (purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular Inc, Sense Diagnostics, Inc, Serenity Medical Inc, Silk Road Medical, Spinnaker Medical, Inc, StimMed, Synchron, Three Rivers Medical Inc, Vastrax, LLC, VICIS, Inc, Viseon Inc; Consultant/advisory board: Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc, Cerebrotech Medical Systems Inc, Cerenovus, Corindus Inc, Endostream Medical Ltd, Imperative Care, Inc. Integra LifeSciences Corp, Medtronic, MicroVention, Minnetronix Neuro, Inc, Northwest University–DSMB Chair for HEAT Trial, Penumbra, Q’Apel Medical Inc, Rapid Medical, Rebound Therapeutics Corp (purchased by Integra LifeSciences Corp), Serenity Medical Inc, Silk Road Medical, StimMed, Stryker, Three Rivers Medical, Inc, VasSol, W.L. Gore & Associates; Principal investigator/steering comment of the following trials: Cerenovus NAPA and ARISE II; Medtronic SWIFT PRIME and SWIFT DIRECT; MicroVention FRED & CONFIDENCE; MUSC POSITIVE; and Penumbra 3D Separator, COMPASS, and INVEST.
Patient consent for publication Obtained.
Ethics approval The patient gave informed consent for the procedure, video recording and publication. Institutional review board approval was deemed unnecessary.
Provenance and peer review Not commissioned; externally peer reviewed.