The cervical approach was the first to be used by neuroangiography pioneers, but due to limited access, drawbacks, and significant complications it was surpassed long ago in favor of the femoral approach. However, common carotid access can be a valuable alternative to femoral access in selected neuroendovascular cases, particularly in emergency procedures involving one of the carotid arteries when the femoral approach is impossible or contraindicated. We describe the successful use of carotid artery access for the treatment of acute stroke in a patient in whom common carotid artery and internal carotid artery tortuosity prevented the delivery of endovascular therapy to the middle cerebral artery via femoral artery access. Endovascular neurosurgeons should be familiar with percutaneous carotid artery access to provide comprehensive endovascular care to the growing subset of patients with complex vascular anatomy.
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