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Percutaneous Closure Device for the Carotid artery: An integrated review and design analysis
Shovan Bhatia1, Giancarlo Riccobono2, Nicholas J Lima3
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Insights
Endovascular thrombectomies for stroke can be improved by direct carotid puncture. A specialized vascular closure device is needed to safely close the carotid artery after this procedure.
Area of Science:
- Neurology
- Vascular Surgery
- Biomedical Engineering
Background:
- Endovascular thrombectomies (EVTs) are standard for acute ischemic stroke.
- Current femoral/radial access for EVTs fails in up to 20% of cases due to complex anatomy.
- Direct carotid puncture (DCP) offers faster cerebral access but lacks suitable closure methods.
Purpose of the Study:
- To address the unmet clinical need for effective vascular closure devices (VCDs) for direct carotid puncture (DCP).
- To review current VCD limitations and propose design requirements for a carotid-specific VCD.
Main Methods:
- Review of existing literature on EVT access and VCD technology.
- Analysis of biomechanical properties and shortcomings of current VCDs.
- Identification of anatomical and functional requirements for a novel carotid closure device.
Main Results:
- Current VCDs designed for femoral artery closure are inadequate for the carotid artery.
- Anatomical differences between femoral and carotid arteries present unique challenges for closure.
- A need exists for a VCD specifically engineered for the unique properties of the carotid artery.
Conclusions:
- Direct carotid puncture is a promising alternative access route for EVT.
- Development of a carotid-specific VCD is crucial for the safe and widespread adoption of DCP.
- Future VCD designs must consider the specific biomechanical and anatomical characteristics of the carotid artery.
Abstract:
Endovascular thrombectomies (EVTs) are the current standard of care therapy for treating acute ischemic strokes. While access through the femoral or radial arteries is routine, up to 20% of EVTs through these sites are unable to access the cerebral vasculature on the first pass. These shortcomings are commonly due to tortuous vasculature, atherosclerotic arteries, and type III aortic arch, seen especially in the elderly population. Recent studies have shown the benefits of accessing the cerebral vasculature through a percutaneous direct carotid puncture (DCP), which can reduce the time of the procedure by half. However, current vascular closure devices (VCDs) designed for the femoral artery are not suited to close the carotid artery due to the anatomical differences. This unmet clinical need further limits a DCP approach. Thus, to foster safe adoption of this potential approach, a VCD designed specifically for the carotid artery is needed. In this review, we outline the major biomechanical properties and shortcomings of current VCDs and propose the requirements necessary to effectively design and develop a carotid closure device.
