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.