2021 Volume 6 Issue 4 Pages 219-226
Objective: Endovascular thrombectomy is generally performed by the femoral artery approach, but in some cases it is difficult to access and cannot be treated. In that case, direct carotid puncture is effective. We report the usefulness of direct carotid puncture in endovascular thrombectomy.
Case Presentations: From January 2017 to December 2020, there were 3 cases of mechanical thrombectomy at our institution where the femoral artery was difficult to approach and the carotid artery was directly punctured during the procedure. Under intravenous anesthesia, the trachea was infused in advance and the neck was slightly bent backward. The direct common carotid artery puncture was performed, a 6Fr super sheath was inserted, and treatment was performed with a suction catheter and stent retriever. After treatment, we removed the sheath and stopped bleeding by manual compression for 20 minutes or longer. The procedure was performed on 3 cases whose target ages were 100 years, 86 years, and 100 years; the obstruction was middle cerebral artery M1 obstruction in 2 cases and anterior cerebral artery A1-A2 bifurcation in 1 case; recanalization was 3, 0, and 3, respectively, in the TICI classification, and complications were puncture site in 1 case. Intubation prevented airway compression. Outcomes were 2, 4, and 4 in mRS, respectively.
Conclusion: Direct carotid puncture may be effective when approaching from the femoral artery is difficult in endovascular thrombectomy.
