While the advantage of mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke with large-vessel obstruction (AIS-LVO) has been demonstrated, poor vascular access may make the procedure impracticable or excessively time-consuming. The authors of this study looked at the safety, as well as the radiographic and functional outcomes, of stroke patients who were treated with MT through direct injection. Patients who underwent attempted MT between 2015 and 2018 were analysed retrospectively using the authors’ prospective AIS-LVO database. Aborted MT (abMT) after failed transfemoral access and attempted MT via DCP were the two groups of patients with prohibitive vascular access.

MT was attempted on 352 patients with anterior circulation AIS-LVO. Vascular access was found restrictive in 37 individuals (10.5 percent). In 19 of the 20 patients, direct carotid access was successfully acquired. In the abMT group, 16 (84 percent) of 19 patients had successful reperfusion. When compared to patients who had abMT after failed transfemoral access, DCP for emergency MT in patients with anterior circulation AIS-LVO and prohibitive vascular access is safe and efficacious, with better recanalization rates, smaller infarct volumes, and improved functional result. In this patient population, DCP should be considered.

Reference Link – https://thejns.org/view/journals/j-neurosurg/135/1/article-p53.xml