INTERVENTIONAL NEURORADIOLOGY The safety and efficacy of the Angio-Seal closure device in diagnostic and interventional neuroangiography setting: a single-center experience with 1,443 closures Serdar Geyik & Kivilcim Yavuz & Ayca Akgoz & Osman Koc & Bora Peynircioglu & Barbaros Cil & Saruhan Cekirge & Isil Saatci Received: 18 January 2007 / Accepted: 2 May 2007 / Published online: 27 June 2007 # Springer-Verlag 2007 Abstract Introduction We evaluated the safety and efficacy of the Angio-Seal closure device used to close arterial puncture sites in patients who had undergone diagnostic cerebral angiography and neurointerventional procedures. Methods A total of 1,443 Angio-Seal devices were placed in 1,099 patients in the Interventional Neuroradiology Unit between May 2005 and August 2006. Of these, 670 were interventional and 745 were diagnostic cerebral angiographic procedures. In 28 patients bilateral puncture of the femoral arteries was performed for endovascular treatment. In 167 patients 286 repeat diagnostic procedures were performed and 30 interventional procedures were followed by re-closure with an Angio-Seal device at the time of repeat puncture. Results The procedural success rate for antegrade closures was 99.7% for all procedures. The device failed in 5 of 745 diagnostic procedures (0.7%). Major complication occurred in one patient only (0.13%) in the diagnostic group. No minor complications were observed in this group. In the interventional group, the major complication rate was 1.4% (10 of 698 closures) and the minor complication rate was 2.4% (17 of 698 closures). However, in the subgroup of patients with cerebral aneurysms who received heparin in combination with antiplatelet agents after the procedure, the major complication rate was 5.3%, but in the carotid/ vertebral stenting group it was 0.8%. Conclusion Our experience in a relatively large series of patients shows that the use of the Angio-Seal STS vascular closure device is safe and effective in patients undergoing cerebral diagnostic angiography and neurointerventional procedures with an acceptable rate of complications, although the complication rate was higher in the group of patients who received heparin and/or antiplatelet medication. Keywords Closure site . Access site . Complication . Angio-Seal . Intervention Introduction The number of diagnostic and therapeutic interventional procedures is increasing worldwide. Thus, access site hemostasis management is a crucial part of all angiographic procedures as such procedures carry the risk of complica- tions including bleeding, hematoma, vessel occlusion, dissection and pseudoaneurysm formation [1, 2]. Systemic heparinization when using coaxial catheter systems or balloon catheters during interventional procedures and premedication with antiplatelet agents before an elective stenting procedure are mandatory. However, the risk of complications tends to increase with the use of anti- coagulation and/or antiplatelet regimens [2, 3]. Hemostasis at the access site has traditionally been achieved by manual compression over the arterial puncture site. Although adequate hemostasis is usually achieved with this technique, time to reach hemostasis is relatively long, and the need for prolonged bed rest after compression leads to patient discomfort and increased costs due to an overnight hospital stay. Also, the effectiveness of manual compression in the setting of systemic anticoagulation is a matter of concerning. Neuroradiology (2007) 49:739–746 DOI 10.1007/s00234-007-0249-6 S. Geyik : K. Yavuz : A. Akgoz : O. Koc : B. Peynircioglu : B. Cil : S. Cekirge : I. Saatci (*) Radiology Department, Hacettepe University Hospitals, Sihhiye Ankara 06100, Turkey e-mail: cekirgesaatci@superonline.com