Discussion
The transcarotid approach has been described as a viable alternative for vascular access in several other procedures, such as aortic repair interventions (2), cerebral angiography (3), endovascular intervention for acute ischemic stroke (4,5), complex pediatric cardiac interventions (6,7), and transcatheter aortic valve implantation (TAVI) (8–10). One case of a diagnostic coronary catheterization via transcarotid approach has also been described (11). This is, to our knowledge, the first reported adult case of a PCI via transcarotid approach.
In a recent meta-analysis, comparing transcarotid versus transfemoral TAVI, transcarotid TAVI seems to be non-inferior to transfemoral TAVI in terms of overall mortality and short-term neurological complications such as transient ischemic attack and stroke (8). As such, safety for performing transcarotid percutaneous interventions has been demonstrated. Since our current experience is limited to this case alone, we cannot make general conclusions regarding the safety of PCI via transcarotid approach. Nonetheless, our patient experienced no adverse neurological or cardiac events during or after the procedure.
For this procedure, the configuration of the catheterization lab was different than the usual configuration used for PCI via the radial or femoral approach. Apart from this adjusted catheterization lab configuration, the materials used for the PCI were the same as what is normally used, including a standard sheath and standard coronary catheters.