Direct carotid puncture for neuroendovascular procedures

Background: Classically, access for neuroendovascular procedures is facilitated via groin or wrist puncture, entering the femoral or radial artery, respectively. However, in some instances, adequate intracranial access is not obtainable with those approaches due to vessel tortuosity or unfavorable anatomy. We describe a thrombectomy for stroke that was complicated by inability to achieve intracranial access via standard approaches. Method: To circumvent difficulties obtaining intracranial access, we entered the arterial circulation via a direct carotid puncture. Conclusion: Direct carotid puncture is an alternative access route for neuroendovascular procedures when intracranial access is not achievable by femoral or radial approaches due to unfavorable vascular anatomy.