{
  "abstract": "Introduction Automated Percutaneous Large-Bore Carotid Artery Access, Flow Reversal, and Closure SystemIntroduction The femoral and radial arteries are used as access routes for acute stroke management and carotid artery stenting. Sometimes, procedures are delayed or stopped due to tortuosity of the supra-aortic vessels. Direct carotid artery access has proven to be a valuable technique for neurointerventions. 1-5 However, complications like dissection, neck hematoma, and death have been reported. Additionally, a lack of reliable closure devices for the access site—due to the absence of dedicated systems—is seen in up to 20% of procedures and can lead to blood loss, neck hematoma, dissections, and death.Material and Methods A highly flexible, atraumatic, large-bore, thin-walled 9-F carotid artery access system and an integrated, fully automated suture-based closure mechanism were developed, including a flow-reversal system for carotid artery stenting (CAS). Successful short-term and long-term pre-clinical studies using carotid ultrasound have been completed, including histology studies conducted in a sheep model.Results More than 20 patients have been successfully treated using carotid, axillary, and femoral artery approaches for various conditions, including carotid endograft placement and stenting. Our experience shows ease of use, excellent safety, and efficacy, with a 100% on-table occlusion rate.Conclusion Automated percutaneous access and closure of the carotid artery with a dedicated system is feasible and will simplify neurointerventional procedures, accelerate endovascular stroke treatment, and make robotic-assisted interventions easier.References Mokin M, et al. Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations. J Neurointervent Surg. 2013;7:108–1132.Scoco AN, et al. Trans-carotid and trans-radial access for mechanical thrombectomy for acute ischemic stroke: a systematic review and meta-analysis. Cureus 2020;12:e88753.Miszczuk M, et al. Direct puncture of the carotid artery as a bailout vascular access technique for mechanical thrombectomy in acute ischemic stroke - the revival of an old technique in a modern setting. Neuroradiology 2021;63:275–2834.Cord BJ, et al. Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke patients with prohibitive vascular access. J Neurosurg. 2021;135:53–635.Allard J, et al. Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and system review. J Neurointervent Surg. 2021:13:809–815.Disclosures A. Wakhloo: 2; C; Stryker NV, JNJ Medtech. 4; C; Neurofine, Prometheus Therapeutics, Deinde Medical, Hyperion Surgical, Endovascular Horizons, VFlow, Fluidbiomed, Lakka, Inretio. 5; C; Neurofine, Prometheus Therapeutics. B. Baxter: 4; C; Neurofine. B. Aurilia: 4; C; Neurofine. 5; C; Neurofine.",
  "authors": [
    {
      "affiliations": [
        "Radiology, Tufts University School of Medicine, Boston, FL"
      ],
      "name": "A Wakhloo"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology, Sutter Pacific Medical Health, San Franciso, CA"
      ],
      "name": "B Baxter"
    },
    {
      "affiliations": [
        "Neurofine Inc, Miramar, FL"
      ],
      "name": "B Aurilia"
    }
  ],
  "title": "E-050 Automated percutaneous large-bore carotid artery access, flow reversal, and closure system",
  "uid": "081d556b-fbca-509e-b9fa-55d851665f05"
}