A case of the direct carotid artery puncture in endovascular thrombectomy

Objective: Endovascular thrombectomy may be a topic treatment in this year, because new evidences and increase in the number of cases will be expected. Elderly patients or arteriosclerosis patients often exhibited difficult access to the occlusive vessel, and it may lead to poor result. The direct common carotid artery puncture is an alternative method in cases of difficult access. Case presentation: A 90-year-old male presented with sudden-onset of the left hemiparesis. Magnetic resonance imaging revealed early ischemic changes in the right deep white matter, and magnetic resonance angiography showed a right middle cerebral artery occlusion. After recombinant tissue plasminogen activator (rt-PA) therapy, his symptom showed no improvement, and endovascular therapy was performed. Right innominate angiography showed that the access to right common carotid artery was difficult, because of anatomical problem. Therefore, a direct common carotid artery puncture was performed and recanalization was achieved using stent retriever. Conclusion: Direct common carotid artery puncture may be technically acceptable in a case of anatomical difficulty to internal carotid artery.