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AJNR - American Journal of Neuroradiology

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Hemostatic Closure Device after Carotid Puncture for Stent and Coil Placement in an Intracranial Aneurysm: Technical Note

Raphaël Blanc^a, Charbel Mounayer^a, Michel Piotin^a, Jean-Claude Sadik^b, Laurent Spelle^a and Jacques Moret^a

^a Departments of Interventional Neuroradiology, Fondation Rothschild, Paris, France
^b Diagnostic Radiology, Fondation Rothschild, Paris, France

View larger version (169K): [in a new window]   FIG 1. Radiograph of the skull shows coiling of the aneurysm with the remodeling technique. Guiding catheter has been advanced into the petrous portion of the right internal carotid artery to facilitate stent delivery across the aneurysm neck.

View larger version (101K): [in a new window]   FIG 2. Photograph of the patient’s neck immediately after the carotid closure shows the external part of the Angio-Seal device. The tension spring (thick arrow) is positioned between the tamper tube compactor (open arrow) and the crimp stop (arrowhead) for 20 min to compact the collagen plug against the adventia of the artery. The bioabsorbable Dexon (polyglycolic acid) suture (thin arrow) is then cut, and the tamper tube compactor is discarded.

View larger version (104K): [in a new window]   FIG 3. Duplex Doppler sonogram of the puncture site, obtained at day 5 after the procedure, shows normal flow velocity inside the carotid lumen. Twinkling artifact (thick arrow) is observed immediately behind the hyperechoic signal of the anchor (arrowheads).

View larger version (133K): [in a new window]   FIG 4. Three-month follow-up color Doppler sonogram of the carotid artery shows that the anchor has totally resorbed. The external collagen plug is persisting and appears as a hypoechoic structure (thick arrow).

View larger version (113K): [in a new window]   FIG 5. Three-month follow-up angiogram shows a normal carotid artery.