CELT vascular closure device for larger NES arteriotomies: A single-center retrospective analysis.

Abstract

Introduction/PurposeThe shift from transfemoral to transradial access in interventional cardiology has gained momentum due to fewer access site complications, earlier ambulation, and improved patient comfort. Adoption in neuroendovascular procedures has been slower due to anatomical challenges, a steeper learning curve, and reliance on transfemoral devices. Shapiro et al. reported a 4.6% total and 1.6% major complication rate with transfemoral mechanical thrombectomy (MT). While transradial MT aims to reduce such risks, small radial arteries pose concerns such as vasospasm and catheter entrapment. For large-bore access sites (>8F), available percutaneous closure options are limited. Vascular closure devices offer immediate hemostasis-even in anticoagulated patients-but data are limited on off-label use in oversized arteriotomies. We present a single-center retrospective experience using a 7F CELT closure device on 9F arteriotomies in MT.Materials/MethodsWe retrospectively reviewed patients from January 2021 to 2023 who underwent endovascular procedures using 9F femoral sheaths closed with a 7F CELT device. Data included demographics, procedural details, antithrombotic use, hemostasis efficacy, and closure-related complications.ResultsMost patients (96.3%) underwent MT. The CELT device achieved hemostasis in line with the primary outcome definition in 93.2% (95% CI [90.3, 96.0]). Major complications included two cases (0.5%) of lower limb ischemia requiring surgical repair. No retroperitoneal hematomas or transfusions occurred.ConclusionThe 7F CELT closure device demonstrated a 93.2% efficacy rate and a 95% complication-free rate when used off-label for 9F arteriotomies, supporting its potential viability in high-acuity neuroendovascular procedures.