Abstract 217: CELT Vascular Closure Device for Larger NES Arteriotomies: A Single center Retrospective Analysis
Authors: Pitiranggon C. , Wheibe E. , Johnston P. A. , Turner R. , Turk A. S. , Vargas J. , Chaudry I. 
Published: January 2025

Introduction/Purpose

The shift from transfemoral to transradial access in interventional cardiology is gaining traction due to benefits such as fewer access site complications, early ambulation, and patient preference. Adoption in the neuroendovascular space has been slower due to an extended learning curve, use of transfemoral devices for transradial approaches, and anatomical challenges. Shapiro et al. reported a 4.6% total and 1.6% major access site complication rate with transfemoral mechanical thrombectomy (MT). Although transradial MT aims to reduce these rates, the smaller radial artery size poses risks, vasospasm and catheter entrapment. Femoral access site complications could be reduced with judicious use of US.

Tools for percutaneous closure of large bore, (>8 Fr), access sites are limited. Vascular closure devices (VCDs) offer advantages like immediate hemostasis and effective hemostasis even with anticoagulants/antiplatelets. These devices are vital for managing hemostasis across arteriotomy sizes. However, the efficacy and safety of using VCDs on arteriotomies larger than designed needed further research to guide VCD size selection.

We present a single center retrospective experience utilizing a novel steel rivet closure device (CELT) in mechanical thrombectomy. The CELT device offers pain free immediate hemostasis, early ambulation (in non MT patients) and the ability to close larger arteriotomies than its stated size.

Materials/Methods

A retrospective review was conducted on patients who underwent endovascular procedures with a 9F femoral sheath insertion and 7F CELT arterial closure device from January 2021 to 2023. Data collected included demographics, medical history, antithrombotic/anticoagulant use, use of GP2b3a inhibitor, procedure type, intraoperative anticoagulation, hemostasis adequacy, and closure‐related complications.

Results

Nearly all patients (385 patients, 96.3%) underwent mechanical thrombectomy. Other procedures included aneurysm embolization (2.25%), carotid stenting (3.25%) and diagnostic angiography (2.75%) in patients with suspected LVO that had resolved at the time of intervention.

The 7F CELT closure device achieved hemostasis in 93.2% (95% CI [90.3,96.0]) of 9F arteriotomies. Adjuvant therapy was required in 6.8% of cases, with manual compression being most common (3.75%, 95% CI [2.1,6.1]). CELT had a 95% complication‐free rate (95% CI [92.4,96.9]), with minor complications like subcutaneous hematomas at 2.25% (95% CI [1.03,4.23]). Device embolization and sandbag use occurred at 0.25% (95% CI [0.01,1.79]). Device malfunction was seen in 1.5% (95% CI [0.55,3.24]). 2 cases of lower limb ischemia required groin exploration which demonstrated failure of the CELT closure device requiring removal and common femoral artery patch angioplasty. There were no cases of retroperitoneal hematoma or patients requiring blood transfusions.

Conclusion

The 7F CELT arterial closure device closes 9F arteriotomies with a 93.2% efficacy rate and 95% complication‐free rate. Despite challenges with larger sites and antiplatelet/thrombolytic therapy, it showed comparable or better than reported rates (Shapiro), making it a viable option for procedures requiring larger sheaths.