Abstract
PurposeTo describe our single-center experience of mechanical thrombectomy (MTE) via a direct carotid puncture (DCP) with regard to indication, time metrics, procedural details, as well as safety and efficacy aspects.MethodsDCP thrombectomy cases performed at our center were retrospectively identified from a prospectively maintained institutional MTE database. Various patient (age, sex, stroke cause, comorbidities), clinical (NIHSS, mRS), imaging (occlusion site, ASPECT score), procedural (indication for DCP, time from DCP to reperfusion, materials used, technical nuances), and outcome data (NIHSS, mRS) were tabulated.ResultsAmong 715 anterior circulation MTEs, 12 DCP-MTEs were identified and analyzed. Nine were left-sided M1 occlusions, one right-sided M1 occlusion, and two right-sided M2 occlusions. DCP was successfully carried out in 91.7%; TICI 2b/3-recanalization was achieved in 83.3% via direct lesional aspiration and/or stent-retrieval techniques. Median time from DCP to reperfusion was 23 min. Indications included futile transfemoral catheterization attempts of the cervical target vessels as well as iliac occlusive disease. Neck hematoma occurred in 2 patients, none of which required further therapy.ConclusionMTE via DCP in these highly selected patients was reasonably safe, fast, and efficient. It thus represents a valuable technical extension of MTE, especially in patients with difficult access.
Highlights
Mechanical thrombectomy (MTE) is the accepted standard of care for patients with acute ischemic stroke due to large vessel occlusion (LVO) as shown by various randomized-controlled trials [1].Many factors have impact on the stroke outcome, with the quality of MTE and the time to reperfusion being crucial
From a prospectively maintained institutional database of all consecutive patients treated with MTE for acute ischemic stroke from January 2017 to March 2020, patients with an anterior circulation occlusion treated by Direct carotid puncture (DCP)-MTE were retrospectively identified
11 procedures were aborted and 10 cases were converted to a secondary DCP
Summary
Mechanical thrombectomy (MTE) is the accepted standard of care for patients with acute ischemic stroke due to large vessel occlusion (LVO) as shown by various randomized-controlled trials [1]. Many factors have impact on the stroke outcome, with the quality of MTE and the time to reperfusion being crucial. These procrastinating factors influence the time spent from groin puncture to thrombus retrieval and are likely to have a negative impact on patient outcome as shown in previous studies [3,4,5]. Neuroradiology (2021) 63:275–283 access and provide a stable platform for subsequent MTE. DCP was the initial standard access route in cerebral angiography before being supplanted by transfemoral, transbrachial, and more recently transradial approaches as catheter navigability improved [6,7,8,9]
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