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Angioseal™ as a hemostatic device for direct carotid puncture during endovascular procedures
Hugo Cuellar1, Leopoldo Guimaraens2, Sudheer Ambekar3
1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA hcuell@lsuhsc.edu.
Insights
Closure devices like Angioseal™ may offer a safe alternative to manual compression for hemostasis after direct carotid artery puncture (DCP) in neuroendovascular procedures, with no observed complications.
Area of Science:
- Vascular Surgery
- Interventional Neuroradiology
- Medical Device Technology
Background:
- Direct carotid artery puncture (DCP) is used for vascular access when peripheral arteries are unavailable.
- Manual compression is the standard hemostasis method after DCP.
- Limited data exists on using closure devices for DCP.
Purpose of the Study:
- To evaluate the safety and efficacy of the Angioseal™ closure device for hemostasis after DCP.
- To assess complications and long-term vascular changes associated with device use.
Main Methods:
- Retrospective review of patients undergoing DCP for neuroendovascular procedures with Angioseal™.
- Analysis of medical charts and imaging for device-related abnormalities.
Main Results:
- Eight patients received Angioseal™ post-DCP with no complications.
- Immediate and 6-month follow-up imaging showed no stenosis or vascular wall abnormalities.
- No adverse clinical reactions were reported.
Conclusions:
- Angioseal™ appears to be a safe and effective off-label option for hemostasis after DCP.
- The device eliminates the need for manual compression without adverse structural or hemodynamic effects.
- Further research with larger cohorts and longer follow-up is warranted.
Introduction:
Direct carotid artery puncture (DCP) is employed in patients with tortuous anatomy and peripheral vascular disease when the peripheral arteries are not available for vascular access. Manual compression is the only method of achieving hemostasis following DCP and, till date, the use of a closure device for DCP has been reported in only one patient. In this study we sought to analyze our experience with the use of closure device for DCP.
Methods:
This is a retrospective study of patients in whom Angioseal™ was used following DCP for neuroendovascular procedures. Medical charts and imaging of these patients was reviewed for any abnormalities pertaining to the use of the closure device.
Results:
A total of eight patients were included in the study. Angioseal™ was used in all the patients. There were no complications related to the use of the closure device in any of the eight patients. Immediate post-procedure angiography done in one patient did not show any structural or hemodynamic abnormalities within the carotid artery lumen. At 6 months follow-up imaging, there was no evidence stenosis or vascular wall abnormality in any of the patients. There were no adverse clinical reactions related to the use of closure device.
Conclusion:
In our experience, Angioseal™ may be a safe and off-label effective closure device for patients undergoing DCP for neuroendovascular procedures. It obviates the need for manual compression without causing any structural or hemodynamic changes within the carotid artery. Larger studies with longer follow-up are required to establish its safety in patients undergoing DCP.
