Access Strategies for Endovascular Intervention in the Carotid Artery: Does the Direct Cervical Approach Have A Role?

Abstract

Endovascular stent placement is rapidly evolving as a potential alternative to surgical endarterectomy in the treatment of carotid artery disease. Currently available information is preliminary and somewhat incomplete, but it does suggest that carotid catheter intervention is likely to become a frequent and successful procedure in the future. Access considerations are of key importance, with the transfemoral technique emerging as the best strategy in most instances. Direct puncture and cannulation of the cervical carotid artery is technically feasible but seldom required. When necessary, a cutdown open approach through a short incision at the base of the neck may offer advantages over the percutaneous technique. Vascular surgeons should be urged to become proficient with all forms of catheter-based procedures, and pay particular attention to carotid artery intervention.