Direct Carotid Exposure for Neuroendovascular Approaches

Objective  The transfemoral approach is a common route for catheterization of the supra-aortic vessels in neuroendovascular therapy. However, in some cases, the patient's anatomy prevents transfemoral catheterization or distal access to the carotid s. In such cases, direct carotid exposure (DCE) for neuroendovascular approaches may be used to treat cerebrovascular diseases. Methods  We present 11 cases in which we were unable to perform the distal approach and DCE was the preferred neuroendovascular treatment procedure. Results  DCE was performed on 11 patients with cerebral aneurysm ( n  = 8), carotid cavernous fistula (CCF) ( n  = 1), malignant brain tumor ( n  = 1), and carotid angioplasty and stenting ( n  = 1). Ten patients were female; one was male. Ages ranged from 63 to 87 years (mean: 71.36 years). Coil embolization was performed on patients with cerebral aneurysm and CCF. The patient with a malignant brain tumor underwent polyvinyl alcohol particle embolization. The only complication was a carotid artery dissection that occurred in one patient during stenting. Conclusion  DCE for neuroendovascular approaches can be used as an alternative for patients with tortuous vasculature access in the femoral route. In such patients, a combination of neuroendovascular treatment and surgery in a hybrid operating room with angiography is preferred.