• Martin Wiesmann, Johannes Kalder, Arno Reich, Sven Dekeyzer, Alexander Riabikin, Anastasios Mpotsaris, and Omid Nikoubashman.
• Department of Neuroradiology, University Hospital RWTH, Aachen, Germany.
• World Neurosurg. 2019 Dec 1; 132: e1-e4.

ObjectiveConventional carotid catheterization is impossible in 2%-5% of acute stroke cases. Surgical carotid cutdown may be a necessary bailout strategy to allow for carotid access. We assessed the effectiveness and safety of surgical carotid cutdown for vascular access in interventional acute stroke treatment.MethodsWe compare imaging and clinical data of 15 consecutive patients, in whom we performed a carotid cutdown for acute stroke treatment with 10 consecutive patients, in whom treatment was discontinued because transfemoral access to the occlusion site was not possible.ResultsBaseline characteristics of both groups were comparable (P ≥ 0.065). Cutdown patients had significantly smaller infarctions (P = 0.031), significantly more often favorable clinical outcome (38% vs. 0% modified Rankin score 0-2, P = 0.046), and a lower mortality (31% vs. 60%, P = 0.222) at 3 months. Other than a small hematoma at the operation site, there were no procedure-related complications.ConclusionsCarotid cutdown is an effective bailout strategy for acute stroke patients, in whom conventional catheterization is not possible.Copyright © 2019 Elsevier Inc. All rights reserved.

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