Neurointervention.  2019 Sep;14(2):131-136. 10.5469/neuroint.2019.00094.

Alternative Transcarotid Approach for Endovascular Treatment of Acute Ischemic Stroke Patients: A Case Series

• Styczen H
• Behme D
• Hesse AC
• Psychogios MN

• KMID: 2458493
• DOI: http://doi.org/10.5469/neuroint.2019.00094

Abstract

PURPOSE
Mechanical thrombectomy has become the standard of care for acute stroke caused by large vessel occlusion. As more patients are treated endovascularly, the number of older patients with tortuous vessels has risen. In these patients, catheterizing the internal carotid artery via a transfemoral approach can be very difficult or even impossible. Therefore, in selected patients, alternative strategies to the transfemoral approach have to be applied.
MATERIALS AND METHODS
We report a case series of six patients undergoing mechanical thrombectomy via a combined transfemoral and transcarotid approach. Puncture of the carotid artery was conducted using roadmap guidance after an unsuccessful transfemoral attempt. Technical aspects and outcomes with this alternative approach were analyzed.
RESULTS
Direct puncture of the carotid artery was achieved in five out of six patients (83%). In three out of six patients (50%), revascularization (modified Thrombolysis in Cerebral Infarction score ≥2b) was restored. No complications related to endovascular therapy were documented. One patient showed good neurological outcome (modified Rankin Scale [mRS] 5 at admission, mRS 1 at discharge).
CONCLUSION
A combined transfemoral/transcarotid approach can be an alternative vascular access in patients with problematic vessel anatomy.

Keyword

Acute ischemic stroke; Carotid artery; Direct carotid puncture; Mechanical thrombectomy; Transcarotid access

MeSH Terms

Carotid Arteries
Carotid Artery, Internal
Catheters
Cerebral Infarction
Humans
Punctures
Standard of Care
Stroke*
Thrombectomy

Figure

• 

  Fig. 1. Left common carotid angiogram showing a biplane roadmap after injection through the SIM 2 catheter placed via transfemoral access (A, antero-posterior view; C, lateral view). An 18 G needle (arrow) was placed cranially to the clavicle bone and navigated in a 45° angle toward the common carotid artery on the biplane roadmap (B, antero-posterior view; D, lateral view).

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