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Case series
Direct carotid artery access for neurointerventional procedures in infants
  1. Flavio Requejo1,
  2. Darío Javier Teplisky2,
  3. Thanh N Nguyen3,
  4. Mohamad Abdalkader4
  1. 1 Department of Pediatric Interventional Neuroradiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
  2. 2 Department of Pediatric Interventional Radiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
  3. 3 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
  4. 4 Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Mohamad Abdalkader, Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA; mohamad.abdalkader{at}


Background Femoral access is the primary route for neurointerventional procedures in children. However, endovascular treatment may not always be possible through a femoral approach, necessitating conversion to alternative access routes.

Objective To review the feasibility and safety of direct carotid puncture (DCP) in infants undergoing neuroendovascular interventions.

Methods We conducted a retrospective review of all infants who underwent DCP as the access route to treat neuroendovascular pathologies between January 2011 and January 2021. Patients’ demographics, clinical presentation, imaging findings, and technical details were reviewed.

Results Between January 2011 and January 2021, five infants aged between 28 and 150 days underwent DCP out of 1129 neuroendovascular interventions performed in our institution (0.4%). All five infants (100%) were diagnosed with intracranial fistulas and were found to have severe tortuosity of the cervical arteries. DCP was performed as the initial access route in 2/5 patients and as crossover after a failed femoral attempt in 3/5 patients. DCP was performed under ultrasound guidance in all patients. Closure was performed by manual compression, without complications. Ultrasound showed patent cervical vessels in all patients at 3 months’ follow-up.

Conclusion Direct carotid access is a feasible and safe alternative route to treat neuroendovascular pathologies in infants and can be considered in cases of inaccessible or failed transfemoral access or in cases with severe arterial tortuosity in infants with intracranial fistulas.

  • technique
  • vascular malformation
  • fistula

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  • Contributors FR: planning, drafting the manuscript; DJT: acquisition of data or analysis, reporting, drafting the manuscript; TNN: review, editing; MA: conception and design, drafting the manuscript, analysis and Interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.