<h3>Purpose</h3> This study was conducted to investigate the feasibility and safety of trans carotid Neuro intervention for a variety of pathologies. <h3>Materials and methods</h3> Since 2018 we implemented a direct carotid access under special considerations to perform a therapeutic approach. A total of 18 patients from our centers were analyzed. Patients were divided into a variety of neurovascular conditions: Carotid Stenting CAS (<i>n</i>= 6), Mechanical Thrombectomy MT (n=5), AVM´s treatment (n=2), intracranial Aneurysms treatment (n=5). <h3>Results</h3> Mean age was 64.3 ± 10.3 years. Major indication to this approach was : anatomical and access limitations. (Two patients with Leriche Syndrome) All cases performed with ultrasound. A 4 Fr. Micro- puncture set were used in all procedures and posteriorly a 6Fr. Introducer was inserted. Technical success in all cases (100%). For MT(n=5): a SOFIA 6Fr for ADAPT was used in 3 cases with TICI 2b-3 in all cases. Combined approach ¨Solumbra¨solitaire and aspiration catheter was used in two cases, one TICI 2a and one TICI 3.For the AVM´s treatment we use a 6Fr guiding catheter and non-detachable microcatheters to inject Onix with a high grade of obliteration. Five aneurysms were treated with this approach ( 2 ICA – ophthalmic; 2 MCA and one AcomA) Mean average time of the procedure was 34.5 min. (ranged 9–59 min)just one bleeding complication observed at the closure device use. In all cases but one we use Angio-Seal 6Fr as closure device. <h3>Conclusion</h3> <h3>Trans Carotid Intervention</h3> was feasible and safe in selected patients in this small series. <h3>References</h3> Yan Chan JC, Edward Chu Yi, Wei Cheung IH, On Tsang AC, Lau KK, Lee R. Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke: literature review and a single-center experience. <i>World Neurosurg</i> 2022 Mar 31:S1878–8750(22)00410–7. DOI: 10.1016/J.WNEU.2022.03.115. EPUB AHEAD of Print. PMID: 35367393. Abe T, Sakata H, Ezura M, Endo H, Tominaga T. Direct carotid puncture for endovascular surgery of intracranial aneurysms: technical note for avoiding complications. <i>Surg Neurol Int</i> 2022 Feb 25;13:69. DOI: 10.25259/SNI_1147_2021. PMID: 35242435; PMCID: PMC8888314 <h3></h3> <b>Do you have any conflict of interest to declare?</b>: No