Direct Carotid Artery Puncture for Endovascular Stroke Treatment

A 77-year-old woman with acute occlusion of the left terminal internal carotid artery (ICA) and proximal middle cerebral artery presented in acute condition with right-sided hemiparesis and aphasia, and an NIHSS score of 20. The extreme vascular tortuosity at the level of the aortic arch and proximal left common carotid artery (CCA) prevented successful navigation of the guiding catheter into the ICA. Eventually, direct puncture of the left CCA was necessary to gain stable access. Complete revascularization was achieved through two thrombectomy maneuvers. The patient had good clinical outcomes and minimal definitive infarction. The puncture site of the CCA was occluded with hemostatic dressing (QuikClot). The option of direct puncture of the carotid artery in challenging anatomy is the subject of this chapter.