Detail analysis of puncture site complications in neuro-endovascular therapy: A single-center analysis

Abstract

Objective: Puncture site complications in neuro-endovascular therapy, which represent a significant cause of morbidity, are often difficult to treat. Vascular closure devices have evolved in endovascular therapy. We analyzed risk factors for puncture site complications and examined the efficacy of hemostasis methods in neuro-endovascular therapy. Methods: This retrospective, observational, single-center study was conducted from January 2021 to January 2023. We enrolled 202 puncture sites of patients who underwent neuro-endovascular therapy at Kawaguchi Municipal Medical Center and analyzed the complications requiring additional intervention. Results: There were 12 (5.94 %) puncture site complications. No patient had permanent puncture-related complications. Univariate analyses revealed that a higher risk of puncture site complications was significantly associated with multiple antiplatelet agents (p = 0.03), hypertension (p = 0.03), scheduled treatment (p < 0.01), higher activated clotting time (ACT) immediately before sheath removal (≥310 s, p < 0.01), and the non-use of Perclose (manual compression or Angio-seal, p < 0.01). Multivariate analyses revealed that puncture site complications were significantly higher in patients with an ACT immediately before sheath removal ≥ 310 s (HR: 10.4, 95 % CI: 2.45–44.15, p < 0.01), scheduled treatment (HR: 10.16, 95 % CI: 1.81–56.95, p < 0.01), and the non-use of Perclose (HR: 21.97, 95 % CI: 2.42–199.34, p < 0.01). Conclusion: A higher ACT immediately before sheath removal was significantly associated with puncture site complications. Perclose is an efficient device, and it may reduce the risk of puncture site complications.

Keywords

• Puncture site complications
• Neuro-endovascular therapy
• ACT
• Perclose
• Angio-seal