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4 . 2025

The role of direct carotid access in endovascular treatment of ischemic stroke. Emergency hospital experience

Abstract

Relevance. Stroke continues to occupy a leading position among the causes of mortality in the population. In the Russian Federation, more than 450 thousand cases of acute cerebrovascular accident are recorded annually, with the vast majority (75–80%) being ischemic stroke. Timely restoration of cerebral blood flow allows minimizing the infarction zone by preserving viable areas in the ischemic penumbra, which significantly improves the prognosis of the disease.

The aim of the study is to analyze the results of endovascular thrombectomy by direct carotid access in the treatment of patients with ischemic stroke.

Material and methods. Within the theoretical section, an analysis of foreign and domestic experience in endovascular treatment of ischemic stroke with complex anatomy was carried out. Within the practical section, the results of our own experience were generalized and analyzed.

Over the past 5 years, 613 endovascular mechanical thrombectomies with occlusion in the anterior circulation basin have been performed at the V.V. Veresaev City Clinical Hospital. Of these, 17 patients underwent direct carotid access. The decision on direct access to the common carotid artery was made with unsuccessful selective catheterization of the common carotid artery on the affected side for 30 minutes.

Results and discussion. Mechanical reperfusion by direct carotid access in combination with systemic thrombolytic therapy was performed in 3 (17.6%) patients. Reperfusion at the TICI-2b-3 level was considered successful. Endovascular reperfusion was successful in 16 (95%) сases. Effective first-pass thrombectomy was performed in 14 (82%) cases. Manual hemostasis after introducer removal was performed in 6 (35.3%) patients, in 11 (64.7%) cases the puncture hole of the common carotid artery was sutured. Symptomatic hemorrhagic transformation was observed in 3 (17.6%) сases. Three patients died. Mortality was 17.6%. The average National Institutes of Health Stroke Scale at discharge was 13.4±6.2 points. In patients with percutaneous puncture, the average time from the beginning of the operation to reperfusion was 62 minutes.

Conclusion. Direct carotid access can be considered as an effective and safe method of mechanical thrombectomy in patients with difficult selective catheterization.

Keywords: stroke; ischemic stroke; endovascular thrombectomy; carotid access; complex anatomy; reperfusion

Funding. The study was not sponsored.

Conflict of interest. The authors declare no conflict of interest.

Authors’ contributions. Study conception and design – Strutsenko M.V.; data collection and handling – Polyanskiy V.D.; processing of the material – Logvinenko P.L.; draft manuscript preparation – Strutsenko M.V., Bolotov P.A.; manuscript revision – Strutsenko M.V., Bolotov P.A., Murtazalieva D.M., Khamitov F.F., Parfenov I.P.

For citation: Strutsenko M.V., Bolotov P.A., Logvinenko P.L., Polyanskiy V.D., Murtazalieva D.M., Khamitov F.F., Parfenov I.P. The role of direct carotid access in endovascular treatment of ischemic stroke. Emergency hospital experience. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (4): 126–31. DOI: https://doi.org/10.33029/1027-6661-2025-31-4-126-131

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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