Safe and effective use of the Celt ACD vascular closure device for rapid hemostasis following direct carotid puncture thrombectomy.

A man in his early 70s presented to the emergency department about 3.5 hours after acute onset right sided hemiplegia and aphasia. CT angiography confirmed an acute occlusion of the M1 segment of the left middle cerebral artery and severe, but stable, dissection of the aortic arch and a large dissecting aortic aneurysm extending into the innominate artery and beyond into the descending aorta. The risk of aggravating existing aortic pathology while trying to navigate from a transfemoral or transradial approach was considered to be very high; therefore, the decision was made to proceed with direct carotid puncture for mechanical thrombectomy. The procedure was successfully completed, and the carotid puncture site was closed without issue using the Celt ACD vascular closure device (Vasorum, Dublin, Ireland). The patient recovered and was discharged home at his prestroke neurologic baseline 9 days later. Here we discuss the safe and effective use of this novel closure device in the setting of direct carotid puncture for neurointerventional procedures.

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Competing interests: AHS: financial Interest/investor/stock options/ownership: Adona Medical, Bend IT Technologies, BlinkTBI, Borvo Medical, Cerebrotech Medical Systems, Code Zero Medical, Cognition Medical, Collavidence, CVAID, E8, Endostream Medical, Galaxy Therapeutics, Hyperion Surgical, Imperative Care, InspireMD, Instylla, Launch NY, Neurolutions, NeuroRadial Technologies (sold to Medtronic in 2021), Neurovascular Diagnostics, Peijia Medical, PerFlow Medical, Piraeus Medical, Q’Apel Medical, QAS.ai, Radical Catheter Technologies, Rebound Therapeutics (purchased 2019 by Integra Lifesciences), Rist Neurovascular (purchased 2020 by Medtronic), Sense Diagnostics, Serenity Medical, Silk Road Medical, Sim & Cure, Spinnaker Medical, StimMed, Synchron, Tulavi Therapeutics, Vastrax, Viseon, Whisper Medical, and Willow Medtech; consultant/advisory board: Amnis Therapeutics, Apellis Pharmaceuticals, Boston Scientific, Canon Medical Systems USA, Cardinal Health 200, Cerebrotech Medical Systems, Cerenovus, Cordis, Corindus, Endostream Medical, Hyperfine Operations, Imperative Care, InspireMD, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Peijia Medical, Penumbra, Piraeus Medical, Q’Apel Medical, Rapid Medical, Serenity Medical, Silk Road Medical, StimMed, Stryker Neurovascular, VasSol, and Viz.ai; national PI/steering committees: Cerenovus EXCELLENT and ARISE II trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE, and SWIFT DIRECT trials; MicroVention FRED trial and CONFIDENCE study; MUSC POSITIVE trial; Penumbra 3D Separator trial, COMPASS trial, INVEST trial, MIVI neuroscience EVAQ trial; Rapid Medical SUCCESS trial; and InspireMD C-GUARDIANS IDE pivotal trial; patent: patent No US 11,464,528 B2, October 11, 2022, Clot retrieval system for removing occlusive clot from a blood vessel, applicant and assignee, Neuravi Limited (Galway), role, co-inventor.