Abstract Number ‐ 81: Safety and Efficacy of Trans‐carotid Intervention in Multiple Scenarios: Medellin Experience Direct Carotid access.

Abstract

Introduction Direct carotid puncture has been validated such as an alternative route to reach the intracranial vasculature. However, this approach has not been considered routinely in INR. A believe of higher risk for neurovascular procedures or major accesssite related complications restrict its use. This study was conducted to investigate the feasibility and safety of trans carotid Neurointervention for a variety of pathologies. Methods Since 2018 we implemented a direct carotid access under special considerations to perform a therapeutic approach. A total of 14 patients from our centers were analyzed. Patients were divided into a variety of neurovascular conditions: Carotid Stenting CAS (n = 2), Mechanical Thrombectomy MT (n = 5), AVM´s treatment (n = 2), intracranial Aneurysms treatment (n = 5). Patient demographics, technical data, intervention time, type of intervention, closure device used, local or systemic complications and a patient perception assessment were registered. Results Mean age was 64.3 ± 10.3 years. all cases but two we treated the patients under General Anesthesia GA. Major indication to this approach was : anatomical and access limitations. (in 12 cases wasn’t possible to reach the ICA through femoral or radial access due to extreme aortic arc tortuosity. Two patients with Leriche Syndrome) All cases performed with ultrasound US assistance. A 4 Fr. Micro‐ puncture set were used in all procedures and posteriorly a 6Fr. Introducer was inserted. Technical success in all cases (100%). Two patients presented mild vasospasm and resolved using IA vasodilators. Both CAS were performed without any complications and none embolic protection device used. For MT(n = 5): a SOFIA 6Fr for ADAPT was used in 3 cases with TICI 2b‐3 in all cases. Combined approach ¨Solumbra¨ solitaire and aspiration catheter was used in two cases, one TICI 2a and one TICI 3. For the AVM´s treatment we use a 6Fr guiding catheter and non‐detachable microcatheters to inject Onix with a high grade of obliteration. Five aneurysms were treated with this approach (2 ICA – ophthalmic; 2 MCA and one AcomA) Mean average time of the procedure was 34.5 min. (ranged 9–59 min) just one bleeding complication observed at the closure device use. In all cases but one we use Angio‐Seal 6Fr as closure device, in a single case where we used a ProGlide suture device we had a serious complication at the puncture site. Conclusions Trans Carotid Intervention TCI. was feasible and safe in selected patients in this small series. A multiple variety of neurovascular conditions would be treated successfully by this way improving the learning curve. Complication rates and clinical outcomes were comparable with those in trans femoral or radial approach.