Intracranial angioplasty and stenting through direct carotid puncture.

BACKGROUND AND PURPOSE

To describe a case of successful intracranial angioplasty and stenting of a symptomatic middle cerebral artery (MCA) stenosis using a transcervical approach.

METHODS

A 73-year-old woman presented with several ischemic strokes in the left MCA distribution. A diagnostic cerebral angiogram demonstrated more than 80% stenosis of her left MCA. Because the patient failed maximal medical therapy, it was decided to perform angioplasty and stenting. Given the patient's tortuous arch and rigid vessels, access was obtained through a transcutaneous puncture with direct visualization of the surgically exposed common carotid artery (CCA).

RESULTS

The patient tolerated well the procedure and after successful stenting her symptoms resolved.

CONCLUSION

Access of the intracranial circulation through direct CCA puncture may be a feasible alternative when the transfemoral access is not possible. The transcervical approach may be safe even with the use of antiplatelet medications and anticoagulation.