The use of vascular closure devices outside the catheterization laboratory after neurointerventional procedures is safe and effective: Evidence from a retrospective study

Purpose: To investigate the feasibility and safety of vascular closure device (VCD) deployment outside the catheterization laboratory. Methods: Medical records were reviewed of all 799 patients (396 men; mean age 56616 years) who underwent deployment of 918 VCDs following diagnostic or therapeutic neurointerventional procedures over a 2-year period at 2 comprehensive stroke centers. The rates of major vascular complications in patients undergoing VCD deployment in and outside the catheterization laboratory were compared. Major vascular complications were adjudicated using definitions by the Society of Interventional Radiology; comparisons were made between different procedure types and closure devices. Results: During the observation period, 103 (11.2%) of 918 VCD deployments were performed outside the catheterization laboratory. Age, gender, procedure type, and device types were not different between the groups. A total of 10 (1.1%) major vascular complications occurred, including dissection requiring angioplasty (n=1), hematoma requiring blood transfusion (n=4), pseudoaneurysm requiring thrombin injection (n=2), and lower limb ischemia necessitating surgical removal of the VCD (n=3). Rates of major vascular complications were not significantly different between VCDs deployed inside the catheterization laboratory [1.0% (8/815)] compared to outside [1.9% (2/103), p=0.3]. Conclusion: VCD deployment outside the catheterization laboratory does not increase the rate of major vascular complications and may be an alternative approach for femoral artery hemostasis when VCD deployment needs to be deferred.