title: Surgical exposure of the carotid artery for endovascular interventional procedures.
abstract: BACKGROUND
  Transfemoral approach for endovascular interventions is not always possible in cases of unfavorable anatomy. We report our experience using a transcervical approach with carotid cut down and direct, controlled puncture of the carotid artery.
  
  
  METHODS
  Four patients underwent surgical exposure of the carotid artery for endovascular procedures. One patient had retrograde placement of a stent in the common carotid artery, and three patients had coiling of an intracranial aneurysm. After the endovascular procedure, the sheath was removed and the vessel was closed, under direct visualization.
  
  
  RESULTS
  The technique allowed access to extracranial and intracranial lesions. There were no access site complications. There were no access site-related cardiac, systemic, or neurologic events.
  
  
  CONCLUSIONS
  Transcervical access with surgical exposure of the carotid artery for direct and controlled vascular puncture is an effective alternative for endovascular extracranial and intracranial procedures in patients in whom the femoral route cannot be used.
authors.affiliation: Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Larrazabal
authors.forename: Paula
authors.initials: P
authors.lastname: Klurfan
authors.forename: Dipanka
authors.initials: D
authors.lastname: Sarma
authors.forename: Thorsteinn
authors.initials: T
authors.lastname: Gunnarsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology / Q000601:surgery*; D009334:Neck Muscles / Q000033:anatomy & histology / Q000601:surgery; D019736:Prostheses and Implants; D015607:Stents; D013536:Suture Techniques; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*
chemical_list: D000925:Anticoagulants; D006493:Heparin