<h3>Objetive</h3> While the benefit of mechanical thrombectomy (MT) for patients with acute ischemic stroke with large-vessel occlusion (AIS-LVO) has been clearly established, difficult vascular access may make the intervention impossible or unduly prolonge. In the following cases, functional and safety outcomes of mechanical thrombectomy via direct carotid puncture were evaluated in patients with acute ischemic stroke with limited vascular access. <h3>Methods</h3> We evaluated seven patients with AIS-LVO who underwent attempted MT in last year with limmited vascular access for aborted MT after failed transfemoral access or attempted MT via DCP. <h3>Results</h3> Of 7 patients with AIS-LVO who underwent attempted MT, Direct carotid access was successfully obtained in all patients, mean age [± SD] 63 ±15 years. Successful reperfusion (thrombolysis in cerebral infarction score 2b or 3) was achieved in 7 patients (100%). Carotid access complications included disection vascular in 1 pacient, with second vascular Access (carotid puncture) required. In 3 patients (42.8%) thrombolysis therapy with IV r-TPA were administered during thrombectomy by direct carotid puncture. 3 patients presented neck hematomas but they did not require any subsequent interventions. All patients required angio-seal vascular closure device for direct carotid Access 6F. We found that the final functional outcome was based on modified Rankin Scale score between 1 and 3 achieve in 5 of 7 patients (71.4%). <h3>Conclusions</h3> DCP for emergency MT in patients with AIS-LVO and prohibitive vascular access is safe and effective and is associated with higher recanalization rates. <h3>References</h3> Dumas V, Kaesmacher J, Ognard J, <i>et al</i>; Jeni, SFNR and the Younicorn Research Collaborations. Carotid artery direct access for mechanical thrombectomy: the carotid artery puncture evaluation (care) study. <i>J Neurointerv Surg</i> 2021 Dec 16:Neurintsurg-2021-017935. <h3></h3> <b>Do you have any conflict of interest to declare?</b>: No