Safety and efficacy of the Perclose suture-mediated closure device following carotid artery stenting under clopidogrel platelet blockade.
The aim of this study was evaluation of a closure device (Perclose, Menlo Park, Calif.) for closure of the femoral artery access site in patients undergoing aggressive anticoagulation and platelet blockade after carotid stenting. Fifty-five patients who received clopidogrel in addition to aspirin and heparin as medication for carotid stenting were included for suture of the femoral access site after using 7- or 8-F guide catheters. The technical success, the time for suture, the clotting parameters, and complications were examined. Follow-up investigations, including ultrasound and clinical examinations, were performed. The groin was checked for possible hematoma, pseudoaneurysm, arteriovenous fistula, and local infection. Technical success was obtained in 51 of 54 patients (94%) after a mean procedure time of 6 min (range 5-10 min). The suture device was not used in one patient (2%) for anatomical reasons and failed to obtain hemostasis in 3 of 54 (6%) patients. In 4 of 54 patients (7%) bleeding was observed at the punctured site 4-6 h after intervention which was treated by a compression bandage. The mean dedicated activated clotting time was 137 s (range 29-287 s) before intervention and 349 s (150-958 s) just before deploying the Perclose device. During follow-up after 2 days (range 2-6 days) and 6 months no further complications of the puncture site were observed except for two large groin hematomas. No major complications occurred. Closure of the femoral access site after carotid stenting using a Perclose closure device is safe and effective even in patients receiving an aggressive anticoagulation and antiplatelet therapy.
Zorger
Niels
N
University of Regensburg Klinikum, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany. NielsZorger@aol.com
Finkenzeller
Thomas
T
Lenhart
Markus
M
Hamer
Okka
O
Paetzel
Christian
C
Borisch
Inghita
I
Toepel
Ingolf
I
Feuerbach
Stefan
S
Link
Johann
J
D000368:Aged; D017130:Angioplasty; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000628:therapy*; D000077144:Clopidogrel; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015607:Stents; D013536:Suture Techniques / Q000295:instrumentation*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine