Purpose Direct Carotid Puncture (DCP) has been validated such as an alternative route to reach the intracranial vasculature. However, this approach has not been considered routinely in INR.This study was conducted to investigate the feasibility and safety of trans carotid Neuro intervention for a variety of pathologies. Materials and methods Since 2018 we implemented a DCP under special considerations to perform a therapeutic approach. A total of 28 patients from our centers were analyzed. Patients were divided into a variety of neurovascular conditions: Carotid Stenting CAS (n = 4), Mechanical Thrombectomy MT (n=10), AVM´s treatment (n=4), intracranial Aneurysms treatment (n=10). Patient demographics, technical data, intervention time, type of intervention, closure device used, local or systemic complications and a patient perception assessment were registered. Results Mean age was 64.3 ± 10.3 years. in all cases but two were treated under GA. Major indication to this approach were: anatomical and access limitations in 24 cases and, two patients with Leriche Syndrome. All cases performed with ultrasound US assistance. A 4 Fr. Micro‐ puncture set were used in all procedures and posteriorly a 6Fr. Introducer was inserted. Technical success in all cases (100%) selected. Two patients presented mild vasospasm and resolved using IA vasodilators. All CAS were performed without any complications and none embolic protection device used. For MT(n=10): a SOFIA 6Fr for ADAPT was used in 6 cases with TICI 2b‐3 in all cases. Combined approach was used in four cases, one TICI 2a and one TICI 3. A total of 10 aneurysms were treated with this approach (4 ICA – ophthalmic; 4 MCA and two AcomA) Mean average time of the procedure was 34.5 min. (ranged 9‐59 min) Only one hemorrhagic complication observed at the closure device use. In all cases but one we use Angio‐Seal 6Fr as closure device, in a single case where we used a ProGlide suture device we had a serious complication at the puncture site. Conclusion Trans Carotid Intervention TCI. was feasible and safe in selected patients in this small series. A multiple variety of neurovascular conditions would be treated successfully by this way improving the learning curve. Complication rates and clinical outcomes were comparable with those in trans femoral or radial approach.