Abstract
Introduction
Tortuous vasculature is a cause of failure of endovascular treatment of intracranial vascular lesions. We report our experience of direct cervical accesses in patients in whom the arterial femoral route was not attainable.
Methods
In this retrospective study, 42 direct punctures of the carotid or the vertebral arteries at the neck were performed in 38 patients. The vessel harboring the intracranial lesion was punctured at the neck above the main tortuosity, a sheath was then positioned under fluoroscopic control to allow a stable access to the intracranial circulation. After the procedure, the sheath was removed and hemostasis was gained either by manual compression or by an arterial closure device (4 of 42, 9%).
Results
The cervical route allowed access to all intracranial lesions in all 42 procedures. A complication was encountered in six procedures (14%) related to the direct puncture. In 2 of the 42 procedures (4%), a transient vasospasm was encountered. A cervical hematoma formed in 3 of the 42 procedures (7%) after sheath withdrawal (one patient in whom an 8F sheath had been used, required surgical evacuation of a hematoma compressing the upper airways; the other patients did well without surgical evacuation). In the remaining patient (1 of 42 procedures, 2%), a small asymptomatic aneurysm at the puncture site was seen on the follow-up angiogram.
Conclusion
Direct cervical arterial approaches to accessing the intracranial circulation is effective in patients in whom the femoral route does not allow the navigation and stabilization of guiding catheters.
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References
Aletich VA, Debrun GM, Misra M et al (2000) The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago. J Neurosurg 93:388–396
Lylyk P, Cohen JE, Ceratto R et al (2002) Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. AJNR Am J Neuroradiol 23:430–436
Halbach VV, Higashida RT, Dowd CF et al (1990) Treatment of carotid-cavernous fistulas associated with Ehlers-Danlos syndrome. Neurosurgery 26:1021–1027
Weill A, Cognard C, Spelle L et al (1998) Endovascular treatment of basilar tip aneurysms after direct puncture of the vertebral artery. AJNR Am J Neuroradiol 19:1554–1556
Koenigsberg RA, Aletich V, Camras L et al (1999) Direct cervical internal carotid access for GDC treatment of an ophthalmic origin carotid aneurysm. Surg Neurol 51:506–508
Terada T, Nakai E, Tsuura M et al (2001) Combined surgery and endovascular stenting for basilar artery stenosis refractory to balloon angioplasty: technical case report. Acta Neurochir (Wien) 143:511–516
Houdart E, Mounayer C, Chapot R et al (2001) Catheter modification for easier cannulation of the carotid artery during angioplasty and stenting. J Endovasc Ther 8:579–582
Eckard DA, Krehbiel KA, Johnson PL et al (2003) Stiff guide technique: technical report and illustrative case. AJNR Am J Neuroradiol 24:275–278
Halbach VV, Higashida RT, Hieshima GB et al (1989) Direct puncture of the proximally occluded internal carotid artery for treatment of carotid cavernous fistulas. AJNR Am J Neuroradiol 10:151–154
Blanc R, Mounayer C, Piotin M et al (2002) Hemostatic closure device after carotid puncture for stent and coil placement in an intracranial aneurysm: technical note. AJNR Am J Neuroradiol 23:978–981
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We declare that we have no conflict of interest.
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Blanc, R., Piotin, M., Mounayer, C. et al. Direct cervical arterial access for intracranial endovascular treatment. Neuroradiology 48, 925–929 (2006). https://doi.org/10.1007/s00234-006-0157-1
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DOI: https://doi.org/10.1007/s00234-006-0157-1