Mechanical Thrombectomy Via Direct Internal Carotid Artery Puncture

Introduction: Transfemoral access is the route of choice for endovascular treatment. However, anatomic variants may be an obstacle, leading to unfavorable outcomes due to difficulty in obtaining access and longer puncture-to-reperfusion times. Alternative routes should be considered in these cases. Objective: To report a case of thrombectomy performed via direct internal carotid artery puncture access. Report: An elderly patient presented with fluctuating neurological deficits (left-sided hemiparesis and dysarthria). Imaging showed ischemia in the right middle cerebral artery territory. The patient was referred for thrombectomy. Due to the tortuosity of the aortic arch, a radial approach was attempted, unsuccessfully. Direct internal carotid artery puncture was performed. The patient was discharged after 7 days with no deficits. Conclusions: Similar cases reported to date have used ultrasound-guided puncture of the common carotid artery. This route was not feasible in the present case, leading to direct puncture of the internal carotid artery. This high-risk maneuver was justified by the adverse clinical picture, and a successful outcome was achieved.