Stitch or seal? Suture-based versus bioabsorbable plug closure devices in transfemoral stroke thrombectomy: a multicenter cohort study

Background Vascular access-site complications are among the most frequent adverse events of endovascular treatment (EVT) for acute ischemic stroke (AIS). Suture-based closure devices (SBD) are widely used in peripheral and cardiac procedures, but their performance has not been specifically assessed in stroke EVT. We aimed to compare SBD with the more commonly used bioabsorbable plug devices (BPD) in transfemoral stroke thrombectomy. Methods We conducted a multicenter retrospective cohort study across seven French tertiary stroke centers. We included consecutive patients undergoing transfemoral EVT for AIS between July 2024 and July 2025, with device-mediated closure and ≥96 hours follow-up. The primary endpoint was any access-site complication; secondary endpoints were complications requiring active intervention and severe complications requiring surgical/endovascular treatment. Inverse probability of treatment weighting with stabilized weights was used to estimate the average treatment effect. Results Among 933 patients, 632 (67.7%) received a BPD and 301 (32.3%) an SBD. The overall complication rate was 4.0%, and was lower with SBD than BPD (1.3% vs 5.2%, P=0.003). In the weighted analysis, SBD use was associated with a lower rate of access-site complications (OR 0.23, 95% CI 0.08 to 0.68, P=0.008) and of complications requiring active intervention (OR 0.16, 95% CI 0.03 to 0.75, P=0.021). Severe complications were numerically less frequent with SBD (0.3% vs 0.8%) but not significantly different. Conclusion Suture-based closure was associated with fewer access-site complications compared with bioabsorbable plugs, suggesting that suture-based devices may be a preferable closure strategy for the large-bore access used in stroke EVT. These findings require confirmation in further studies.