Alternative Transcarotid Approach for Endovascular Treatment of Acute Ischemic Stroke Patients: A Case Series
10.5469/neuroint.2019.00094
- Author:
Hanna STYCZEN
1
;
Daniel BEHME
;
Amelie Carolina HESSE
;
Marios Nikos PSYCHOGIOS
Author Information
1. Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany. hanna.styczen@med.uni-goettingen.de
- Publication Type:Case Report
- Keywords:
Acute ischemic stroke;
Carotid artery;
Direct carotid puncture;
Mechanical thrombectomy;
Transcarotid access
- MeSH:
Carotid Arteries;
Carotid Artery, Internal;
Catheters;
Cerebral Infarction;
Humans;
Punctures;
Standard of Care;
Stroke;
Thrombectomy
- From:Neurointervention
2019;14(2):131-136
- CountryRepublic of Korea
- Language:English
-
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.
