This study states that the Mechanical thrombectomy is now the accepted standard of care for patients with acute ischemic stroke due to large vessel occlusion, as documented by five randomized trials. The point of the present article is that directly percutaneously puncturing the common carotid artery (CCA) might be an “elegant solution” to deliver the thrombectomy device when transfemoral access is not possible. Severe aortoiliac disease and type III arches can prevent successful cannulation of the CCA. The authors point out that interventionalists can waste a lot of time attempting to gain carotid access via the transfemoral approach in these patients, and time is of the essence for patients with acute carotid artery occlusion. The incidence of neck hematoma associated with DCP has been reported in other series ranging from 9% to 14%. The authors agree that the safety and efficacy of the closure devices used for DCP “should be addressed in larger series.” The authors also note that surgical exposure of the CCA could be another option.

Although the authors suggested DCP could be a useful adjunct for patients requiring mechanical thrombectomy for carotid artery occlusion, the obvious next evolutionary step would be to apply it to all patients requiring carotid intervention.

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