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New devices and techniques
Case series
Use of a dedicated open transcarotid access system for neurovascular disease
  1. Nanthiya Sujijantarat1,
  2. Daniela Renedo1,
  3. Joseph Antonios1,
  4. Andrew B Koo2,
  5. Abdelaziz Amllay3,
  6. Kamil Nowicki4,
  7. Branden J Cord5,
  8. Ryan Hebert1,
  9. Adam de Havenon6,
  10. Kevin N Sheth4,
  11. Nils H Petersen4,
  12. Charles Matouk1
    1. 1Neurosurgery, Yale University, New Haven, Connecticut, USA
    2. 2Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
    3. 3Department of Neurological Surgery, Yale University Department of Neurosurgery, New Haven, Connecticut, USA
    4. 4Yale University School of Medicine, New Haven, Connecticut, USA
    5. 5Department of Neurosurgery, University of California Davis Health System, Sacramento, California, USA
    6. 6Department of Neurology, Yale University, New Haven, Connecticut, USA
    1. Correspondence to Dr Charles Matouk, Neurosurgery, Yale University, New Haven, Connecticut, USA; charles.matouk{at}yale.edu

    Abstract

    Background Transcarotid artery revascularization (TCAR) is an increasingly popular technique for the management of extracranial carotid stenosis. Its off-label use in the treatment of intracranial neurovascular disease is poorly described. Our objective is to describe the use of a dedicated open transcarotid access system for the treatment of neurovascular pathologies other than extracranial carotid stenosis.

    Methods We conducted a retrospective review of a prospectively maintained database of consecutive patients who underwent treatment of neurovascular disease at a single academic center using the ENROUTE Transcarotid Arterial Sheath. Demographics, procedural characteristics, and patient outcomes were reported.

    Results Twenty patients were included in the study between September 2017 and March 2023. The following pathologies were treated: intracranial atherosclerotic disease (ICAD, nine patients), complex cervico-petrous carotid disease (five patients), intracranial aneurysms (three patients), and large vessel occlusion-acute ischemic stroke (three patients). Eighteen of the 20 cases were performed with active carotid flow reversal. All cases were successfully completed. There were no access-related complications. One periprocedural complication was incurred: a microguidewire perforation during an exchange maneuver for the treatment of ICAD.

    Conclusion An open transcarotid approach using a dedicated transcarotid system may offer a safe alternative access strategy for the endovascular treatment of complex neurovascular pathologies when a traditional transfemoral or transradial approach is contraindicated or failed.

    • Aneurysm
    • Stroke
    • Atherosclerosis
    • Blood Flow

    Data availability statement

    The relevant anonymized patient-level data area is available upon reasonable request from the authors.

    https://doi.org/10.1136/jnis-2024-021599

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      Data availability statement

      The relevant anonymized patient-level data area is available upon reasonable request from the authors.

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      Footnotes

      • NHP and CM are joint senior authors.

      • X @Jpantonios

      • Contributors NS collected and analyzed data, and wrote the manuscript. AA and BJC collected data. DR, JPA, ABK, KN, RMH, AH, and KNS edited the manuscript. NHP and CCM oversaw the project and edited the final manuscript.

      • 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 BJC received consulting fees from QApel, Penumbra, and Silk Road. CCM serves as site-PI for TCAR-DWI (Silk Road Medical), national-PI for NITE1 (Silk Road Medical), and is a paid consultant for Silk Road Medical.

      • 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.