Safety and efficacy of the Perclose suture-mediated closure device following carotid artery stenting under clopidogrel platelet blockade

Eur Radiol. 2004 Apr;14(4):719-22. doi: 10.1007/s00330-003-2143-x. Epub 2003 Nov 11.

Abstract

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.

MeSH terms

  • Aged
  • Angioplasty
  • Carotid Artery, Internal
  • Carotid Stenosis / therapy*
  • Clopidogrel
  • Female
  • Femoral Artery
  • Follow-Up Studies
  • Hemostasis, Surgical / instrumentation
  • Humans
  • Male
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Stents*
  • Suture Techniques / instrumentation*
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use*
  • Time Factors

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine