Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke: A single center experience and review of the literature

Endovascular thrombectomy (EVT) for acute ischemic stroke via direct carotid puncture (DCP) has been commonly reported as case reports and series in the literature. However, the reported procedural risk and therapeutic outcome associated with this approach were variable. In this study, we aim to establish the role and safety profile of this alternative access technique by describing our single-center experience and conducting a comprehensive review of the literature. A retrospective review of consecutive patients at our center with large vessel occlusion (LVO) treated with DCP access was conducted between 2018-2020. In addition, a literature review of studies published from 2012-2021 following PRISMA guidelines was conducted. During the 3-year period, 11 patients with LVO were treated with EVT using DCP technique in our local cohort. 216 cases were found in the literature search. A combined total of 227 cases were reviewed separately and collectively. Combining the data, DCP access was successfully achieved in 93.3% of the cases. 76.6% achieved satisfactory recanalization (mTICI≥2b). DCP-related complications were seen in 20.3% of cases. 32.4% patients were functionally independent (mRS ≤ 2) upon follow up. Results from the literature review and our experience illustrate DCP as a feasible approach for EVT. The role of DCP as a bailout is iterated despite a higher complication risk, which may be imperative in low-volume stroke centers. Further studies to evaluate the role of DCP as a primary vascular access technique for EVT in selected cases could be explored.