Carotid access for cardiac catheterization: revisiting the past for a complex intra-arterial approach

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Vascular Surgery

Background:

• Traditional arterial access for angiography included brachial, femoral, and radial approaches.
• Pediatric invasive procedures sometimes utilize alternative sites like the carotid artery.
• Severe peripheral arterial occlusive disease presents challenges for standard angiography access.

Observation:

• A patient with critical limb ischemia requiring coronary angiography had severe peripheral arterial occlusive disease.
• Standard transfemoral or transradial access was deemed unsuitable for this patient.
• Collaboration with cardiothoracic surgery was established.

Findings:

• Carotid artery cutdown was successfully performed in the cardiac catheterization laboratory.
• Diagnostic coronary angiography was achieved via the carotid access.
• Intravascular ultrasound was also successfully performed.

Implications:

• Carotid cutdown represents a viable alternative arterial access for complex coronary angiography.
• This approach can be crucial in patients with contraindications to standard arterial access sites.
• Multidisciplinary collaboration is key for managing challenging interventional cases.