{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T15:14:27Z","timestamp":1783437267961,"version":"3.54.6"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"16","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,4,20]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Endovascular treatment of ruptured intracranial aneurysms can be particularly challenging in patients with a right-sided aortic arch and concomitant carotid artery stenosis, where stable catheterization via conventional transfemoral routes is often impossible. Direct carotid puncture is a potential alternative. However, conventional sheaths can transiently occlude the carotid artery and increase the risk of cerebral ischemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>An 87-year-old patient with subarachnoid hemorrhage due to a ruptured intracranial aneurysm presented with a right-sided aortic arch and severe calcified stenosis of the left common carotid artery. Given the tortuous and stenotic vascular anatomy, transfemoral access was discontinued. Percutaneous direct carotid puncture of the left common carotid artery was performed using an elastic needle with an outer diameter of 1.7 mm. This low-profile access allows microcatheter navigation and successful coil embolization without perioperative ischemic or hemorrhagic complications. Hemostasis was achieved using simple manual compression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>When conventional endovascular access is precluded by complex vascular anatomy, particularly in cases complicated by carotid artery stenosis, direct carotid puncture using an elastic needle may offer a safer and less invasive alternative. This approach provides a feasible option in anatomically challenging situations in which standard sheaths would increase the risk of ischemic complications.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25869\">https:\/\/thejns.org\/doi\/10.3171\/CASE25869<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25869","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:23:04Z","timestamp":1783434184000},"source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous direct carotid puncture using an elastic needle for coil embolization of a ruptured cerebral aneurysm with right-sided aortic arch and carotid stenosis: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9498-1134","authenticated-orcid":true,"given":"Yugo","family":"Maeda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Matsue Red Cross Hospital, Matsue, Shimane, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naohiko","family":"Ohbayashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Matsue Red Cross Hospital, Matsue, Shimane, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Yasuoka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Matsue Red Cross Hospital, Matsue, Shimane, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Nabika","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Matsue Red Cross Hospital, Matsue, Shimane, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobutaka","family":"Horie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Biomedical and Health sciences, Hiroshima University, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Br Heart J","first-page":"722","article-title":"Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies","volume":"28","author":"Hastreiter","year":"1966","unstructured":"Hastreiter ARD\u2019Cruz IACantez TNamin EPLicata R.Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies. Br Heart J. 1966;28(6):722-739. doi:10.1136\/hrt.28.6.722"},{"issue":"5","key":"bib2","series-title":"Circulation","first-page":"1047","article-title":"Right aortic arch. Types and associated cardiac anomalies","volume":"50","author":"Knight","year":"1974","unstructured":"Knight LEdwards JE.Right aortic arch. Types and associated cardiac anomalies. Circulation. 1974;50(5):1047-1051. doi:10.1161\/01.cir.50.5.1047"},{"issue":"1","key":"bib3","series-title":"NMC Case Rep J","first-page":"9","article-title":"Carotid artery stenting in right-sided aortic arch: a case report","volume":"3","author":"Ohtani","year":"2016","unstructured":"Ohtani TYamazaki TOhtaki HCarotid artery stenting in right-sided aortic arch: a case report. NMC Case Rep J. 2016;3(1):9-12. doi:10.2176\/nmccrj.2015-0007"},{"issue":"5","key":"bib4","series-title":"J Neuroendovasc Ther","first-page":"317","article-title":"A case of ruptured cerebral aneurysm with a right-sided aortic arch treated by coil embolization","volume":"7","author":"Ichinose","year":"2013","unstructured":"Ichinose NKiura YSakamoto SA case of ruptured cerebral aneurysm with a right-sided aortic arch treated by coil embolization. J Neuroendovasc Ther. 2013;7(5):317-322. doi:10.5797\/jnet.7.317"},{"issue":"1","key":"bib5","series-title":"J Neuroendovasc Ther","first-page":"2024-0094","article-title":"Mechanical thrombectomy for medium-vessel occlusion with a right-sided aortic arch: a case report","volume":"19","author":"Kimura","year":"2024","unstructured":"Kimura SYagi RMarutani AMechanical thrombectomy for medium-vessel occlusion with a right-sided aortic arch: a case report. J Neuroendovasc Ther. 2024;19(1):2024-0094. doi:10.5797\/jnet.cr.2024-0094"},{"issue":"11","key":"bib6","series-title":"Acta Neurochir (Wien)","first-page":"2169","article-title":"Carotid artery stenting in a patient with right-sided aortic arch with an aberrant left subclavian artery","volume":"153","author":"Sakamoto","year":"2011","unstructured":"Sakamoto SShibukawa MTani ICarotid artery stenting in a patient with right-sided aortic arch with an aberrant left subclavian artery. Acta Neurochir (Wien). 2011;153(11):2169-2173. doi:10.1007\/s00701-011-1114-2"},{"issue":"3","key":"bib7","series-title":"J Neuroendovasc Ther","first-page":"170","article-title":"A case of the direct carotid artery puncture in endovascular thrombectomy","volume":"9","author":"Miyamoto","year":"2015","unstructured":"Miyamoto MIshi YAjiki MYasuda HUshikoshi S.A case of the direct carotid artery puncture in endovascular thrombectomy. J Neuroendovasc Ther. 2015;9(3):170-174. doi:10.5797\/jnet.tn.2015-0010"},{"issue":"2","key":"bib8","series-title":"J Neuroendovasc Ther","first-page":"122","article-title":"Carotid artery stenting by direct puncture of carotid artery through a small skin incision: case report","volume":"6","author":"Oshima","year":"2015","unstructured":"Oshima RKondo RNagahata MCarotid artery stenting by direct puncture of carotid artery through a small skin incision: case report. J Neuroendovasc Ther. 2015;6(2):122-126. doi:10.5797\/jnet.6.122"},{"issue":"1","key":"bib9","series-title":"J Vasc Surg","first-page":"249","article-title":"Carotid artery stenting by direct percutaneous puncture","volume":"54","author":"Guimaraens","year":"2011","unstructured":"Guimaraens LTheron JCasasco ACuellar H.Carotid artery stenting by direct percutaneous puncture. J Vasc Surg. 2011;54(1):249-251. doi:10.1016\/j.jvs.2010.11.119"},{"issue":"3","key":"bib10","series-title":"J Neuroendovasc Ther","first-page":"143","article-title":"Use of direct carotid artery puncture access for flow diverter embolization combined with coil embolization: a case report","volume":"13","author":"Funakoshi","year":"2019","unstructured":"Funakoshi YHatano TAndo MUse of direct carotid artery puncture access for flow diverter embolization combined with coil embolization: a case report. J Neuroendovasc Ther. 2019;13(3):143-148. doi:10.5797\/jnet.cr.2018-0109"},{"issue":"7","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"1502","article-title":"Direct carotid puncture for the endovascular treatment of anterior circulation aneurysms","volume":"27","author":"Nii","year":"2006","unstructured":"Nii KKazekawa KOnizuka MDirect carotid puncture for the endovascular treatment of anterior circulation aneurysms. AJNR Am J Neuroradiol. 2006;27(7):1502-1504."},{"issue":"12","key":"bib12","series-title":"Neuroradiology","first-page":"925","article-title":"Direct cervical arterial access for intracranial endovascular treatment","volume":"48","author":"Blanc","year":"2006","unstructured":"Blanc RPiotin MMounayer CSpelle LMoret J.Direct cervical arterial access for intracranial endovascular treatment. Neuroradiology. 2006;48(12):925-929. doi:10.1007\/s00234-006-0157-1"},{"issue":"6","key":"bib1","series-title":"Br Heart J","first-page":"722","article-title":"Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies","volume":"28","author":"Hastreiter","year":"1966","unstructured":"Hastreiter ARD\u2019Cruz IACantez TNamin EPLicata R.Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies. Br Heart J. 1966;28(6):722-739. doi:10.1136\/hrt.28.6.722"},{"issue":"5","key":"bib2","series-title":"Circulation","first-page":"1047","article-title":"Right aortic arch. Types and associated cardiac anomalies","volume":"50","author":"Knight","year":"1974","unstructured":"Knight LEdwards JE.Right aortic arch. Types and associated cardiac anomalies. Circulation. 1974;50(5):1047-1051. doi:10.1161\/01.cir.50.5.1047"},{"issue":"1","key":"bib3","series-title":"NMC Case Rep J","first-page":"9","article-title":"Carotid artery stenting in right-sided aortic arch: a case report","volume":"3","author":"Ohtani","year":"2016","unstructured":"Ohtani TYamazaki TOhtaki HCarotid artery stenting in right-sided aortic arch: a case report. NMC Case Rep J. 2016;3(1):9-12. doi:10.2176\/nmccrj.2015-0007"},{"issue":"5","key":"bib4","series-title":"J Neuroendovasc Ther","first-page":"317","article-title":"A case of ruptured cerebral aneurysm with a right-sided aortic arch treated by coil embolization","volume":"7","author":"Ichinose","year":"2013","unstructured":"Ichinose NKiura YSakamoto SA case of ruptured cerebral aneurysm with a right-sided aortic arch treated by coil embolization. J Neuroendovasc Ther. 2013;7(5):317-322. doi:10.5797\/jnet.7.317"},{"issue":"1","key":"bib5","series-title":"J Neuroendovasc Ther","first-page":"2024-0094","article-title":"Mechanical thrombectomy for medium-vessel occlusion with a right-sided aortic arch: a case report","volume":"19","author":"Kimura","year":"2024","unstructured":"Kimura SYagi RMarutani AMechanical thrombectomy for medium-vessel occlusion with a right-sided aortic arch: a case report. J Neuroendovasc Ther. 2024;19(1):2024-0094. doi:10.5797\/jnet.cr.2024-0094"},{"issue":"11","key":"bib6","series-title":"Acta Neurochir (Wien)","first-page":"2169","article-title":"Carotid artery stenting in a patient with right-sided aortic arch with an aberrant left subclavian artery","volume":"153","author":"Sakamoto","year":"2011","unstructured":"Sakamoto SShibukawa MTani ICarotid artery stenting in a patient with right-sided aortic arch with an aberrant left subclavian artery. Acta Neurochir (Wien). 2011;153(11):2169-2173. doi:10.1007\/s00701-011-1114-2"},{"issue":"3","key":"bib7","series-title":"J Neuroendovasc Ther","first-page":"170","article-title":"A case of the direct carotid artery puncture in endovascular thrombectomy","volume":"9","author":"Miyamoto","year":"2015","unstructured":"Miyamoto MIshi YAjiki MYasuda HUshikoshi S.A case of the direct carotid artery puncture in endovascular thrombectomy. J Neuroendovasc Ther. 2015;9(3):170-174. doi:10.5797\/jnet.tn.2015-0010"},{"issue":"2","key":"bib8","series-title":"J Neuroendovasc Ther","first-page":"122","article-title":"Carotid artery stenting by direct puncture of carotid artery through a small skin incision: case report","volume":"6","author":"Oshima","year":"2015","unstructured":"Oshima RKondo RNagahata MCarotid artery stenting by direct puncture of carotid artery through a small skin incision: case report. J Neuroendovasc Ther. 2015;6(2):122-126. doi:10.5797\/jnet.6.122"},{"issue":"1","key":"bib9","series-title":"J Vasc Surg","first-page":"249","article-title":"Carotid artery stenting by direct percutaneous puncture","volume":"54","author":"Guimaraens","year":"2011","unstructured":"Guimaraens LTheron JCasasco ACuellar H.Carotid artery stenting by direct percutaneous puncture. J Vasc Surg. 2011;54(1):249-251. doi:10.1016\/j.jvs.2010.11.119"},{"issue":"3","key":"bib10","series-title":"J Neuroendovasc Ther","first-page":"143","article-title":"Use of direct carotid artery puncture access for flow diverter embolization combined with coil embolization: a case report","volume":"13","author":"Funakoshi","year":"2019","unstructured":"Funakoshi YHatano TAndo MUse of direct carotid artery puncture access for flow diverter embolization combined with coil embolization: a case report. J Neuroendovasc Ther. 2019;13(3):143-148. doi:10.5797\/jnet.cr.2018-0109"},{"issue":"7","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"1502","article-title":"Direct carotid puncture for the endovascular treatment of anterior circulation aneurysms","volume":"27","author":"Nii","year":"2006","unstructured":"Nii KKazekawa KOnizuka MDirect carotid puncture for the endovascular treatment of anterior circulation aneurysms. AJNR Am J Neuroradiol. 2006;27(7):1502-1504."},{"issue":"12","key":"bib12","series-title":"Neuroradiology","first-page":"925","article-title":"Direct cervical arterial access for intracranial endovascular treatment","volume":"48","author":"Blanc","year":"2006","unstructured":"Blanc RPiotin MMounayer CSpelle LMoret J.Direct cervical arterial access for intracranial endovascular treatment. Neuroradiology. 2006;48(12):925-929. doi:10.1007\/s00234-006-0157-1"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/16\/article-CASE25869.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/16\/article-CASE25869.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/16\/article-CASE25869.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:23:05Z","timestamp":1783434185000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/16\/article-CASE25869.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":24,"journal-issue":{"issue":"16"},"URL":"https:\/\/doi.org\/10.3171\/case25869","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}