A case of the direct carotid artery puncture in endovascular thrombectomy

Abstract

• Abstract • Objective: Endovascular thrombectomy may be a topic treatment in this year, because new evidences and increase in the number of cases will be expected. Elderly patients or arteriosclerosis patients often exhibited difficult access to the occlusive vessel, and it may lead to poor result. The direct common carotid artery puncture is an alternative method in cases of difficult access. Case presentation: A 90-year-old male presented with sudden-onset of the left hemiparesis. Magnetic resonance imaging revealed early ischemic changes in the right deep white matter, and magnetic resonance angiography showed a right middle cerebral artery occlusion. After recombinant tissue plasminogen activator (rt-PA) therapy, his symptom showed no improvement, and endovascular therapy was performed. Right innominate angiography showed that the access to right common carotid artery was difficult, because of anatomical problem. Therefore, a direct common carotid artery puncture was performed and recanalization was achieved using stent retriever. Conclusion: Direct common carotid artery puncture may be technically acceptable in a case of anatomical difficulty to internal carotid artery.• Key words • direct carotid artery puncture, endovascular thrombectomy, stroke, cerebral vessel occlusion 5 7 1-1

Use of Direct Carotid Artery Puncture Access for Flow Diverter Embolization Combined with Coil Embolization: A Case Report

“…In fact, we select direct puncture of the CCA when a catheter cannot be induced to the ICA in preoperative DSA. Direct puncture of the CCA is effective in cases where a transfemoral approach is difficult, and is performed in various endovascular treatments including acute revascularization, 6,7) carotid artery stenting, 8,9) and cerebral aneurysm coil embolization. 10,11) Angiospasm and vascular dissection have been reported as complications of direct puncture of the CCA, 7,10) although hematoma formation often becomes the primary issue in endovascular treatments that require antiplatelet drug administration or systemic heparinization.…”

“…10,11) Angiospasm and vascular dissection have been reported as complications of direct puncture of the CCA, 7,10) although hematoma formation often becomes the primary issue in endovascular treatments that require antiplatelet drug administration or systemic heparinization. [6][7][8][9][10][11] When a hematoma forms around the CCA, dyspnea may arise from compression of the airway. Oshima et al 8) recommended direct puncture of the CCA under direct visualization by making a small incision rather than the percutaneous approach, to make certain of the puncture and hemostasis, and that a sheath is passed through the subcutaneous tissue to be fixed.…”

Availability of tracheal shift in the chest X-ray image as pre-treatment evaluation of mechanical thrombectomy

“…[1][2][3][4][5][6][7][8] However, various factors might cause difficulties in guiding catheter (GC) induction, including the aortic arch structure, arterial tortuosity or calcification, and atherosclerotic stenosis. [9][10][11][12][13][14][15][16][17][18][19][20] Previous studies have indicated that the interval between treatment initiation and final recanalization had positive correlation with GC induction and favorable prognosis. 3,[9][10][11][12][13][16][17][18][20][21][22][23] For better prognosis, prompt change in approach route is necessary when difficulties are encountered in GC induction through the right common femoral artery (CFA), the most easily accessible artery during MT.…”

“…10,20 However, direct CCA puncture of the affected side is considered when GC induction remains despite changes in device and operator. 10,18,19 Additionally, RA puncture may be considered in patients with osteoarthritis, which leads to difficulties in extension from the fixed position. In addition, RA puncture might be also considered in patients undergoing dialysis with shunt vessel in the elbow.…”

“…In these patients, the approach route change including alternative puncture point was considered prior to MT. Therefore, to shorten time to final recanalization, advanced disinfection and covering of the upper right arm and the affected side of the neck 13,[18][19][20] effectively facilitate rapidly changing the approach route. Ultimately, these measures result in favorable prognosis when GC induction is difficult.…”