• Kirill Orlov, Anil Arat, Alexander Osiev, Vadim Berestov, Kudret Aytemir, Mehmet Akif Topcuoglu, and Ethem Murat Arsava.
• E.N. Meshalkin Siberian Federal Biomedical Research Center, Novosibirsk, Russian Federation; Novosibirsk State Medical University, Novosibirsk, Russian Federation.
• World Neurosurg. 2019 Apr 1; 124: 459463.e2459-463.e2.

BackgroundTransseptal puncture has been widely used by cardiologists to reach the left side of the heart through a transvenous access. Rarely, it also can be used to pass into the supra-aortic arteries from the venous side when conventional transarterial access pathways (transfemoral, transradial/brachial routes, or direct carotid puncture) are likely to fail.Case DescriptionWe report 2 cases of transvenous femoral access followed by transseptal access to aorta to treat dissecting carotid artery aneurysms at the level of the skull base with flow diverters. In one case, multiple cervical arterial bypass operations and in the other a rare anomaly of the aortic arch precluded endovascular treatment through conventional routes.ConclusionsTransvenous-transseptal access enabled treatment of both cases easily and without complications. On follow-up computed tomography angiograms, both flow diverters were patent, there were no residual aneurysms, and no neurologic or cardiac adverse events in either patient.Copyright © 2019 Elsevier Inc. All rights reserved.

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