Endovascular thrombectomies (EVTs) are the current standard of care therapy for treating acute ischemic strokes. While access through the femoral or radial arteries is routine, up to 20% of EVTs through these sites are unable to access the cerebral vasculature on the first pass. These shortcomings are commonly due to tortuous vasculature, atherosclerotic arteries, and type III aortic arch, seen especially in the elderly population. Recent studies have shown the benefits of accessing the cerebral vasculature through a percutaneous direct carotid puncture (DCP), which can reduce the time of the procedure by half. However, current vascular closure devices (VCDs) designed for the femoral artery are not suited to close the carotid artery due to the anatomical differences. This unmet clinical need further limits a DCP approach. Thus, to foster safe adoption of this potential approach, a VCD designed specifically for the carotid artery is needed. In this review, we outline the major biomechanical properties and shortcomings of current VCDs and propose the requirements necessary to effectively design and develop a carotid closure device.
- Carotid artery
- Vascular closure device
- Mechanical thrombectomy
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Contributors All authors significantly contributed to this manuscript. Concept and design: RGT, SB, GR, NJL, JTC, DWP, RD. Data acquisition: SB, GR, NJL, JTC, DWP. Data analysis and interpretation: All authors. First draft of the manuscript: SB. Revision of the manuscript: All authors. Approval of final manuscript for submission: All authors. RGT is the guarantor of the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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Competing interests RGT reports stock ownership of Medtronic, Inc., outside the submitted work. DWP is an employee and shareholder of Medtronic, Inc., but his contributions to this work pre-date his employment and stock ownership. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Provenance and peer review Not commissioned; externally peer reviewed.