Combined Surgical and Endovascular Carotid Access for Endovascular Thrombectomy in Acute Ischemic Stroke

Abstract

Conventional carotid catheterization is impossible in 2%-5% of acute stroke cases. Surgical carotid cutdown may be a necessary bailout strategy to allow for carotid access. We assessed the effectiveness and safety of surgical carotid cutdown for vascular access in interventional acute stroke treatment. We compare imaging and clinical data of 15 consecutive patients, in whom we performed a carotid cutdown for acute stroke treatment with 10 consecutive patients, in whom treatment was discontinued because transfemoral access to the occlusion site was not possible. Baseline characteristics of both groups were comparable (P ≥ 0.065). Cutdown patients had significantly smaller infarctions (P= 0.031), significantly more often favorable clinical outcome (38% vs. 0% modified Rankin score 0-2, P= 0.046), and a lower mortality (31% vs. 60%, P=0.222) at 3 months. Other than a small hematoma at the operation site, there were no procedure-related complications. Carotid cutdown is an effective bailout strategy for acute stroke patients, in whom conventional catheterization is not possible.