Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke.

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  • Additional Information
    • Source:
      Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101517079 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1759-8486 (Electronic) Linking ISSN: 17598478 NLM ISO Abbreviation: J Neurointerv Surg
    • Publication Information:
      Original Publication: London : BMJ Publishing Group, c2009-
    • Subject Terms:
      Brain Ischemia/*surgery ; Carotid Artery, Internal/*surgery ; Endovascular Procedures/*methods ; Punctures/*methods ; Stroke/*surgery ; Thrombectomy/*methods; Adult ; Aged ; Aged, 80 and over ; Brain Ischemia/diagnostic imaging ; Carotid Artery, Internal/diagnostic imaging ; Endovascular Procedures/instrumentation ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stroke/diagnostic imaging ; Stroke/etiology ; Thrombectomy/instrumentation ; Treatment Outcome
    • Abstract:
      Background: Mechanical thrombectomy is the standard of care for acute ischemic strokes with proximal intracranial occlusion. Arterial access is commonly achieved with femoral artery puncture, although this is not always possible. In this case series, we describe 11 cases of anterior circulation stroke where direct carotid puncture was used to obtain vascular access.
      Methods and Materials: A review of a prospectively maintained thrombectomy database over a 2-year period (August 2016 - August 2018) was undertaken to identify cases where direct carotid access was performed. CT and angiographic imaging were reviewed. Indications for carotid access, techniques used, technical success of procedure, recanalization rates, procedure-related complications, and patient outcomes were assessed.
      Results: Eleven patients out of 498 overall thrombectomy procedures (2.2% thrombectomies) underwent direct carotid access. Median National Institutes of Health Stroke Scale was 20. Seventy three percent of patients received intravenous thrombolysis. The direct carotid approach was performed following the failed femoral approach due to unfavorable aortic arch anatomy, vessel tortuosity, and severe atherosclerotic disease. Direct carotid puncture was successful in 10 patients, and unsuccessful in one. Successful recanalization (TICI 2b-3) was achieved in eight patients. One patient had spontaneously recanalized on angiography. There was failed recanalization in one patient with tandem ICA and M1 occlusion. Carotid access complications included one patient with both neck hematoma and asymptomatic ICA dissection, and one of delayed central retinal artery occlusion.
      Conclusion: This case series highlights direct carotid puncture as a successful alternative when the femoral approach is not possible, allowing thrombectomy in patients who would otherwise be unsuitable.
      Competing Interests: Competing interests: None declared.
      (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
    • Contributed Indexing:
      Keywords: stroke; thrombectomy
    • Publication Date:
      Date Created: 20190408 Date Completed: 20190819 Latest Revision: 20190819
    • Publication Date:
      20221213
    • Accession Number:
      10.1136/neurintsurg-2018-014586
    • Accession Number:
      30954938