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Updated: May 6, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Transcervical access in acute ischemic stroke
Ashutosh P Jadhav1, Marc Ribo2, Ramesh Grandhi3
1Department of Neurology, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Transcervical access offers rapid recanalization for acute ischemic stroke patients with large vessel occlusive disease. This approach overcomes transfemoral challenges in tortuous anatomy, improving treatment outcomes.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Surgery
Background:
- Large vessel occlusive disease (LVOD) necessitates rapid recanalization for favorable prognosis.
- Standard transfemoral endovascular approaches face challenges in tortuous vasculature.
- Alternative access routes are crucial for effective acute stroke intervention.
Observation:
- A retrospective review identified 7 patients undergoing acute endovascular reperfusion via transcervical approach.
- Patients presented with severe stroke (NIHSS 8-27).
- Significant time was previously spent on transfemoral attempts (20-90 min) before switching to transcervical access.
Findings:
- Transcervical access enabled rapid recanalization (7-49 min post-access) in all cases.
- High-quality reperfusion (TICI 2b/3) was achieved in 87.5% of patients with left MCA occlusions.
- One case of neck hematoma occurred, managed with intubation. All patients survived at 2-month follow-up (mRS 0-4), except one with a large infarct.
Implications:
- Direct transcervical access is a viable and effective strategy for acute ischemic stroke reperfusion.
- This method facilitates faster and higher-quality recanalization compared to transfemoral attempts in complex cases.
- Future research should optimize hemostasis and identify ideal candidates for direct carotid access in acute stroke management.
Background:
Large vessel occlusive disease portends a poor prognosis unless recanalization is rapidly achieved. Endovascular treatment is typically performed via a transfemoral approach, but catheterization of the occluded vessel can be problematic in cases of extensive vessel tortuosity.
Methods:
A retrospective review of a prospectively maintained database identified 7 patients who underwent acute endovascular reperfusion therapy via transcervical approach.
Results:
We identified 7 patients. Admission NIHSS ranged from 8-27 and recanalization occurred between 7-49 min of carotid access. Prior to carotid access, 20-90 min were spent attempting target vessel catheterization via the transfemoral approach. All occlusions were in the left MCA. In 87.5% of patient, TICI2b/3 recanalization was achieved. Neck hematoma formation occurred in one case requiring elective intubation. At 2 months followup, all patients had survived with mRS 0-4 except for one patient who had a large infarct despite recanalization.
Conclusions:
Transcervical access for acute ischemic stroke leads to rapid and high quality recanalization. Future studies will focus on improved hemostasis and early identification of patients who would benefit the most from direct carotid access for acute stroke.
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