Mechanical thrombectomy via direct carotid artery approach for the treatment of acute anterior circulation large vessel occlusion

Background: Mechanical thrombectomy (MT) has become an important treatment method for acute anterior circulation large vessel occlusion. The carotid artery approach is a fast and effective alternative when the transfemoral approach is difficult due to vascular variation. The present study reports on seven cases of acute anterior circulation stroke where direct carotid approach was used to obtain vascular access. Methods and materials: Patients with acute anterior circulation large vessel occlusion treated via carotid artery access between January 2018 and January 2020 were retrospectively analyzed. Brain computed tomography (CT) and angiographic imaging results, indications for carotid artery approach and technical aspects of the method, modified thrombolysis in cerebral infarction (mTICI), procedure-related complications, and patient outcomes were evaluated. Results: Seven patients were treated using a direct carotid artery approach. Among the seven cases, four patients were treated using percutaneous carotid artery puncture, and two patients were treated with emergency carotid artery incision and thrombectomy. The remaining case involved carotid artery puncture for MCA thrombectomy, followed by carotid artery incision for carotid artery thrombectomy. The carotid artery puncture point was exposed via surgical incision and sutured after MT. Modified Rankin Scale (MRS) scores 90 days after surgery showed good prognosis in three patients, poor prognosis in four patients. Conclusion: This case series highlights the advantage of using a transcarotid approach to bypass anatomical barriers to achieve faster reperfusion when the femoral approach is not possible. The carotid artery puncture point was surgically exposed and sutured to reduce the incidence of postoperative complications.