• Sandro Benichi, Arturo Consoli, Oguzhan Coskun, Anne Boulin, Adrien Wang, Georges Rodesch, and Federico Di Maria.
• Department of Pediatric Neurosurgery, Necker-Enfants Maladies Hospital, Paris, France. Electronic address: sandro.benichi@gmail.com.
• World Neurosurg. 2019 Apr 1; 124: 848684-86.

BackgroundMechanical thrombectomy for acute ischemic stroke recently proved its superiority to standard medical management alone. With the increasing number of procedures, practitioners are exposed to unexpected situations that may lead to failure of access and significantly worse clinical outcome. Being able to plan the procedure and use alternative techniques may be useful in case of peculiar anatomy.Case DescriptionWe report here the case of a 60-year-old man referred to our institution for an acute ischemic stroke. The patient had an initial National Institutes of Health Stroke Scale score of 19. The patient's medical history revealed an unspecified cervical treatment at the level of C5-C6 20 years previously. Magnetic resonance imaging showed a left M1 occlusion and the absence of ipsilateral common carotid. The digital subtraction angiography revealed an anastomosis through the left inferior and superior thyroid artery. Mechanical thrombectomy was performed through direct cervical access with a TICI 3 recanalization score.ConclusionsAbsence of viable access to perform mechanical thrombectomy during acute ischemic stroke is a rare but pejorative event. Direct common carotid puncture, even in its distal segment, when necessary is a feasible technique to perform internal carotid catheterization.Copyright © 2019 Elsevier Inc. All rights reserved.

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