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Direct carotid puncture in acute ischaemic stroke intervention
  1. Elisa Colombo,
  2. Lorenzo Rinaldo,
  3. Giuseppe Lanzino
  1. Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Giuseppe Lanzino; lanzino.giuseppe{at}


Endovascular intervention for acute ischaemic stroke care is mostly performed in older patients, often with unfavourable aortic and supra-aortic anatomy, as well as cardiovascular comorbidities. A significant subset of them may benefit from transcervical access as the initial approach for mechanical thrombectomy. In fact, direct carotid artery puncture in these cases has the advantage to bypass the anatomical obstacles and achieve faster reperfusion. Caution is advised when common carotid artery access is pursued in order to avoid adverse events, including haematoma formation, iatrogenic arterial dissection and sheath kinking. In spite of potential complications, direct carotid puncture in acute ischaemic stroke intervention overcomes challenging angioarchitecture and may reduce the rate of poor clinical outcomes associated with delayed revascularisation in certain cases.

  • brain
  • embolic
  • plaque
  • stroke
  • thrombectomy

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  • Contributors GL: interpreted the data and revised the manuscript for intellectual content. LR: revised the manuscript for intellectual content. EC: drafted the manuscript for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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