title: Feasibility of combined surgical and endovascular carotid access for interventional treatment of ischemic stroke.
abstract: BACKGROUND
  Rapid recanalization of occluded vessels is crucial for good clinical outcome in acute ischemic stroke. Endovascular treatment is usually performed via a transfemoral approach, but catheterization of the carotid arteries can be problematic in cases of difficult anatomy or vascular pathologies in some cases.
  
  
  OBJECTIVE
  To describe our experience with a technique involving surgical access to the carotid artery and consecutive transcarotid endovascular thrombectomy in patients with acute stroke.
  
  
  METHODS
  In a retrospective review of a prospectively maintained registry we identified 6 patients who underwent acute endovascular thrombectomy via a surgical access to the carotid artery.
  
  
  RESULTS
  Admission National Institute of Health Stroke Scale (NIHSS) ranged from 7 to 23. Intracranial recanalization (thrombolysis in cerebral infarction, TICI≥2b) was achieved in all patients (100%). Recanalization was achieved within 19±5 min after establishing carotid access. One patient developed a small neck hematoma, which was surgically removed without complications. No complications related to endovascular therapy were seen. At 3 months' follow-up, five patients had survived. Three patients (50%) had regained excellent neurological function (modified Rankin Scale, mRS 0-1).
  
  
  CONCLUSIONS
  Surgical carotid access for endovascular stroke treatment is feasible, with considerable advantages, in patients with expected problematic access or for whom transfemoral endovascular carotid access has failed.
authors.affiliation: Department of Neuroradiology, University Hospital Aachen, Aachen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
authors.affiliation: Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Aachen, Aachen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kalder
authors.affiliation: Department of Neurology, University Hospital Aachen, Aachen, Germany.
authors.forename: Arno
authors.initials: A
authors.lastname: Reich
authors.affiliation: Department of Neuroradiology, University Hospital Aachen, Aachen, Germany.
authors.forename: Marc-Alexander
authors.initials: MA
authors.lastname: Brockmann
authors.affiliation: Department of Radiology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Othman
authors.affiliation: Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Aachen, Aachen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Greiner
authors.affiliation: Department of Neuroradiology, University Hospital Aachen, Aachen, Germany Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Jülich, Germany.
authors.forename: Omid
authors.identifier: http://orcid.org/0000-0002-2055-4217
authors.initials: O
authors.lastname: Nikoubashman
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000601:surgery*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D015424:Reperfusion / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*
keywords: Catheter; Embolic; Intervention; Stroke; Thrombectomy