title: Angioseal™ as a hemostatic device for direct carotid puncture during endovascular procedures.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA hcuell@lsuhsc.edu.
authors.forename: Hugo
authors.initials: H
authors.lastname: Cuellar
authors.affiliation: Department of Interventional Neuroradiology, Hospital General de Catalunya, Neuroangiografia Terapeutica, Barcelona, Spain Department of Interventional Neuroradiology, Hospital Nuestra Señora del Rosario, Terapeutica Endovascular y Percutanea, Madrid, Spain.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Guimaraens
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Sudheer
authors.initials: S
authors.lastname: Ambekar
authors.affiliation: Department of Interventional Neuroradiology, Hospital General de Catalunya, Neuroangiografia Terapeutica, Barcelona, Spain.
authors.forename: Elio
authors.initials: E
authors.lastname: Vivas
authors.affiliation: Department of Interventional Neuroradiology, Hospital Nuestra Señora del Rosario, Terapeutica Endovascular y Percutanea, Madrid, Spain.
authors.forename: Jacques
authors.initials: J
authors.lastname: Theron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020212:Carotid Artery Injuries / Q000628:therapy*; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006489:Hemostatic Techniques / Q000009:adverse effects; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D011677:Punctures; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics
keywords: Angioseal; direct carotid; vascular closure device