Immediate Femoral Closure Without Mobility Restrictions: Using the CELT ACD® for Neuroendovascular Interventions

BACKGROUND AND OBJECTIVES: A vascular closure device that provides rapid hemostasis is useful for neuroendovascular patients, especially for those with altered mental status or high intracranial pressure that limits compliance with bedrest. CELT ACD ® (arterial closure device) has demonstrated effectiveness and safety in non-neurological cohorts, and thus, the aim of this study was to evaluate the effectiveness of CELT in neuroendovascular interventions. METHODS: We conducted a prospective cohort study at our institution, enrolling consecutive patients undergoing neuroendovascular intervention with femoral access and subsequent CELT closure. We used a CELT-first approach for femoral closure during the study period, with all patients undergoing immediate head-of-bed (HOB) elevation postprocedurally. Primary outcomes included immediate device failure, time to hemostasis (TTH), time to HOB elevation, and risk of access-site hematoma 12 hours after hemostasis (delayed hematoma). RESULTS: Fifty consecutive patients undergoing neuroendovascular interventions were closed with CELT. All patients (n = 50, 100%) underwent immediate postprocedure HOB elevation after a straight-leg test, and there was no immediate device failure or delayed hematoma. The average TTH and HOB/mobility liberalization was 1.1 (±2.2) minutes. There was no lower extremity ischemia attributable to CELT closure. CONCLUSION: In this prospective study, we reported the first experience with CELT closure in neuroendovascular interventions and found an excellent safety and efficacy profile. CELT may be considered first line for patients requiring rapid TTH and early HOB elevation, particularly in the context of high intracranial pressure concerns.