All roads lead to Rome -- Direct cervical carotid artery access in carotid artery intervention

Carotid artery stenting (CAS) is an alternative treatment for patients with severe carotid artery stenosis, especially those with prohibitively high surgical risks. 1 The routine vascular access for CAS is the femoral route. Although the technical success rate reported in a large series have been relatively high, 2,3 difficulty in accessing the supraaortic vessels from the femoral approach still accounts for procedural failure in 2% to 7% of cases. 4 The reasons for this failure may be tortuosity and redundancy of the aortic arch, congenital anomalous or aberrant cephalad trunk configuration, or stenosis or occlusion in the abdominal aorta.