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J Neurointerv Surg. 2015 Feb;7(2):108-13. doi: 10.1136/neurintsurg-2013-011007. Epub 2014 Jan 9.

Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations.

Author information

1
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
2
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
3
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
4
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Jacobs Institute, Buffalo, New York, USA.

Abstract

BACKGROUND:

Challenging anatomy for carotid artery access can result in a delay to achieve successful recanalization in patients with acute ischemic stroke. Our objective was to study emergent direct percutaneous carotid artery puncture as an alternative access approach for acute endovascular stroke interventions.

METHODS:

We reviewed cases of acute ischemic stroke in which direct carotid artery puncture was used for access. We also reviewed current literature relevant to this subject.

RESULTS:

We describe the technical aspects, limits, and potential complications associated with direct carotid artery puncture for intracranial acute ischemic stroke interventions, and present cases to illustrate the utility of this access approach.

CONCLUSIONS:

Direct carotid artery puncture is a feasible alternative to transfemoral artery access in cases of stroke with difficult anatomy, including unfavorable arch type, carotid tortuosity, or an ostial lesion.

KEYWORDS:

Artery; Stroke; Technique

PMID:
24408927
DOI:
10.1136/neurintsurg-2013-011007
[Indexed for MEDLINE]
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