Neurosurgeon performing carotid artery puncture

Direct Carotid Artery Puncture: A Breakthrough in Stroke Thrombectomy?

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Avery Sinclair in Health & Wellness November 2025 • 4 min read.

"New research explores a novel approach to stroke treatment, offering hope for patients with difficult vascular access."


Acute ischemic stroke is a leading cause of disability and death worldwide. One of the most effective treatments for acute ischemic stroke is thrombectomy, a procedure to remove blood clots from blocked arteries in the brain. Timely intervention is crucial, as rapid recanalization—restoring blood flow—significantly improves patient outcomes.

However, accessing the occluded vessel can be challenging, especially in elderly patients or those with significant arteriosclerosis (hardening of the arteries). Traditional methods, such as transfemoral or transbrachial approaches, may be hindered by tortuous (twisted) arteries or anatomical variations. These difficulties can prolong the procedure, leading to poorer outcomes for patients.

Now, a groundbreaking study published in the Journal of Neurosurgical Sciences explores a novel approach: direct common carotid artery (CCA) puncture. This technique involves directly accessing the carotid artery in the neck to perform thrombectomy. The study presents a series of cases where this method was successfully employed, offering new hope for patients with previously difficult-to-treat stroke.

What is Direct Common Carotid Artery (CCA) Puncture?

Neurosurgeon performing carotid artery puncture

Direct CCA puncture involves directly accessing the common carotid artery in the neck with a needle and inserting a catheter (a thin, flexible tube). This provides a direct route to the blocked vessel in the brain, bypassing potential obstacles in the aorta or other arteries. The procedure is typically performed under ultrasound guidance to ensure accuracy and minimize complications.

The study authors reported on three cases where direct CCA puncture was used for acute thrombectomy. In all cases, traditional access methods were deemed unsuitable due to anatomical challenges, such as aortic aneurysms (bulges in the aorta) or tortuous arteries.

  • Case 1: An 83-year-old female with a left middle cerebral artery (M1) occlusion and a history of aortic and femoral artery aneurysms, making transfemoral access inappropriate. Direct CCA puncture was performed, and recanalization was achieved using a combination of aspiration and stent retriever techniques.
  • Case 2: A 93-year-old female with acute right internal carotid artery (ICA) occlusion and a high aortic arch with a tortuous innominate artery, making transfemoral access difficult. Direct CCA puncture was performed, and recanalization was achieved after withdrawing the 5MAX ACE from the catheter, continuous blood aspiration from the side port of 6Fr catheter could not be obtained, showing that distal end of the 6-Fr sheath maybe clogged with clot. The distal end of catheter was moved from ICA to CCA to release the possible clot to the external artery.
  • Case 3: An 87-year-old female with acute right internal carotid artery (ICA) occlusion and a high aortic arch with a tortuous innominate artery. Direct CCA puncture was selected after attempts from trans-femoral or brachial approach. ADAPT was applied, resulting in immediate TICI 3 recanalization.
In all three cases, the direct CCA puncture technique facilitated successful recanalization, with the TICI scores showing 2a or 3 reperfusion of blood flow. Postoperative imaging confirmed no puncture-related complications, such as hemorrhage (bleeding) or occlusion (blockage) of the carotid artery.

The Future of Stroke Treatment: Is Direct CCA Puncture Here to Stay?

The study authors acknowledge the potential risks associated with direct CCA puncture, including bleeding, hematoma formation, and carotid artery occlusion. However, they emphasize that with careful technique and ultrasound guidance, these risks can be minimized. Further research is needed to evaluate the long-term safety and efficacy of this approach and to identify the ideal patient population for its use. The direct CCA puncture shows promise as a valuable alternative in the toolbox of interventional neurologists, potentially improving outcomes for select stroke patients.

About this Article -

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Everything You Need To Know

1

What is direct common carotid artery (CCA) puncture, and how does it aid in stroke treatment?

Direct common carotid artery (CCA) puncture is a technique where the common carotid artery in the neck is directly accessed with a needle to insert a catheter. This provides a direct route to blocked vessels in the brain, bypassing obstacles like twisted arteries or aortic aneurysms, facilitating thrombectomy. This is especially helpful when traditional methods such as transfemoral or transbrachial approaches are challenging due to complex anatomy.

2

In what scenarios would direct CCA puncture be considered over traditional methods like transfemoral or transbrachial approaches for thrombectomy?

Direct CCA puncture is considered when traditional methods are unsuitable due to anatomical challenges such as aortic aneurysms, tortuous arteries, or a high aortic arch. These conditions can make it difficult to navigate catheters to the blocked vessel in the brain using transfemoral or transbrachial approaches. Direct CCA puncture provides a more direct route, potentially reducing procedure time and improving outcomes.

3

What are the potential risks associated with direct CCA puncture, and how are these risks managed?

Potential risks associated with direct CCA puncture include bleeding, hematoma formation, and carotid artery occlusion. These risks are managed through careful technique, ultrasound guidance, and postoperative monitoring. Although the study showcases promising outcomes, further research is needed to evaluate the long-term safety and efficacy of the direct CCA puncture approach.

4

How did the direct CCA puncture technique improve patient outcomes in the cases presented, specifically regarding recanalization?

In the cases presented, the direct CCA puncture technique facilitated successful recanalization, as indicated by TICI scores of 2a or 3, representing reperfusion of blood flow. For instance, in one case involving an 83-year-old female with aortic and femoral artery aneurysms, direct CCA puncture enabled recanalization using aspiration and stent retriever techniques, where transfemoral access was inappropriate. These outcomes underscore the potential of direct CCA puncture to overcome anatomical barriers and improve outcomes.

5

What implications does the direct CCA puncture technique have for the future of acute ischemic stroke treatment and for interventional neurologists?

Direct CCA puncture shows promise as a valuable alternative in the treatment of acute ischemic stroke, particularly for patients with challenging vascular anatomies. It expands the toolbox of interventional neurologists, providing another option when traditional methods are not feasible. While further research is needed to fully evaluate its long-term safety and efficacy, direct CCA puncture has the potential to improve outcomes for select stroke patients by enabling faster and more effective thrombectomy.

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