Transcarotid Access for Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis and Systematic Review

Zhong, Allison; Kamal, Haris; Uddin, Anaz; Feldstein, Eric; Shapiro, Steven D.; Chung, Joon Yong; Ogarro, Maziyah; Friedman, Rebecca; Simmons, Josh; Graifman, Gillian; Kurian, Christeena; Kaur, Gurmeen; Mayer, Stephan A.; Chong, Ji Y.; Gandhi, Chirag D.; Al‐Mufti, Fawaz

doi:10.1016/j.jstrokecerebrovasdis.2022.106428

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…The thrombectomy for AIS patients via the femoral artery is a standard procedure within neurosurgery. In a small subset of patients, direct carotid puncture can be conducted as an alternative approach, but with risks of carotid artery dissection and neck hematomas [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Dual-sized hollow particle incorporated fibroin thermal insulating coatings on catheter for cerebral therapeutic hypothermia

Gao

Jiang

et al. 2023

Bioactive Materials

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Section: Discussionmentioning

confidence: 99%

Dual-sized hollow particle incorporated fibroin thermal insulating coatings on catheter for cerebral therapeutic hypothermia

Gao

Jiang

et al. 2023

Bioactive Materials

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“…Historically, percutaneous direct carotid puncture was used frequently for cervical and cerebral angiography 8. This technique lost favor as endovascular catheter technology improved and paved the way for safer catheter navigation by femoral and radial approaches 9. In modern times, direct percutaneous carotid puncture is used infrequently, but it can be used for neurointervention9 and cardiac intervention10 when alternate routes are unavailable or deemed higher risk.…”

Section: Discussionmentioning

confidence: 99%

“…This technique lost favor as endovascular catheter technology improved and paved the way for safer catheter navigation by femoral and radial approaches 9. In modern times, direct percutaneous carotid puncture is used infrequently, but it can be used for neurointervention9 and cardiac intervention10 when alternate routes are unavailable or deemed higher risk. The risks of percutaneous transcarotid intervention have been studied in small case series,11–13 but they are generally not well known given the limited experience in the medical literature.…”

Section: Discussionmentioning

confidence: 99%

Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique

Kim

Samarage

Zarrin

et al. 2022

J NeuroIntervent Surg

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BackgroundRecent advances in endovascular devices have allowed access and targeting of perivascular tissues of the peripheral circulation. The perivascular tissues of the cervical and cranial circulations have many important structures of clinical significance, yet the feasibility and safety of such an approach has not been demonstrated.ObjectiveTo evaluate the safety of a novel endovascular transmural approach to target the perivascular tissues of the common carotid artery in swine.MethodsA micro-infusion device was positioned in the carotid arteries of three Yorkshire pigs (six carotid arteries in total), and each carotid artery was punctured 10 times in the same location to gain access to the perivascular tissues. Digital subtraction angiography was used to evaluate vessel injury or contrast extravasation. MRI and MR angiography were used to evaluate evidence of cerebral ischemia or vessel injury. Post-mortem tissue analysis was performed to assess the level of extravascular hematoma and intravascular dissection.ResultsNone of the tested carotid arteries showed evidence of vessel injury (dissection or perforation) or intravascular thrombosis. MRI performed after repeated puncture was negative for neck hematoma and brain ischemia. Post-mortem tissue analysis of the carotid arteries showed mild adventitial staining with blood, but without associated hematoma and without vessel dissection.ConclusionRepeated puncture of the carotid artery to gain access to the perivascular tissues using a novel endovascular transmural approach is safe in a swine model. This represents a novel approach to various tissues in close proximity to the cervical and cranial vasculature.

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“…In these situations, EVT through an alternative access route may be beneficial. Commonly used alternative approaches are through the radial, common carotid or brachial artery [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, the small vessel diameter and the large amount of vascular anatomical variations may lead to a complex procedure, requiring specific experience of the interventionist [16,17]. Carotid access may lead to a reduced procedure duration because of the shorter distance to the intracranial occlusion and the ability to bypass challenging vasculature (such as tortuous aortic arch or supra-aortic arteries) [12]. Complications related to carotid access can however be severe and may result in poor patient outcomes [12,18].…”

Section: Introductionmentioning

confidence: 99%

Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry

Collette

Ven

Luijckx

et al. 2023

JCM

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Background: Endovascular thrombectomy (EVT) through femoral access is difficult to perform in some patients with acute ischemic stroke due to challenging vasculature. We compared outcomes of EVT through femoral versus alternative arterial access. Methods: In this observational study, we included patients from the MR CLEAN Registry who underwent EVT for acute ischemic stroke in the anterior circulation between 2014 and 2019 in the Netherlands. Patients who underwent EVT through alternative and femoral access were matched on propensity scores in a 1:3 ratio. The primary endpoint was favorable functional outcome (modified Rankin Scale score ≤ 2) at 90 days. Secondary endpoints were early neurologic recovery, mortality, successful intracranial reperfusion and puncture related complications. Results: Of the 5197 included patients, 17 patients underwent EVT through alternative access and were matched to 48 patients who underwent EVT through femoral access. Alternative access was obtained through the common carotid artery (n = 15/17) and brachial artery (n = 2/17). Favorable functional outcome was less often observed after EVT through alternative than femoral access (18% versus 27%; aOR, 0.36; 95% CI, 0.05–2.74). The rate of successful intracranial reperfusion was higher for alternative than femoral access (88% versus 58%), although mortality (59% versus 31%) and puncture related complications (29% versus 0%) were more common after alternative access. Conclusions: EVT through alternative arterial access is rarely performed in the Netherlands and seems to be associated with worse outcomes than standard femoral access. A next step would be to compare the additional value of EVT through alternative arterial access after failure of femoral access.

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Transcarotid Access for Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis and Systematic Review

Cited by 9 publications

References 24 publications

Dual-sized hollow particle incorporated fibroin thermal insulating coatings on catheter for cerebral therapeutic hypothermia

Dual-sized hollow particle incorporated fibroin thermal insulating coatings on catheter for cerebral therapeutic hypothermia

Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique

Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry

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