Читать книгу Interventional Cardiology - Группа авторов - Страница 58

StarClose is a device that applies a 4‐mm low profile nitinol clip entirely on the external surface of the artery with no permanent intravascular component (Figures 2.6 and 2.7). The tines of the clip grasp the arterial tissue and close the arteriotomy in a purse string fashion. The device consists of the clip applier and a proprietary 6 Fr sheath. After conclusion of cardiac catheterization, the working sheath is changed over a wire to the proprietary sheath, with further blunt dissection during the process to ease subsequent advancement of the 12 Fr clip applier through the skin and subcutaneous tissue. The clip applier has a vessel locator, which is inserted into the sheath, until the clip applier snaps into the sheath. A button is depressed which deploys small flexible nitinol wings at the end of the vessel locator, inside the artery. The entire assembly is withdrawn until resistance is felt, indicating apposition of the wings against the inner vessel wall. The sliding element with the attached clip is then depressed splitting the sheath and applies the clip to the arterial wall at the end of the assembly. At this stage, it is very important to ensure that the skin does not block the “splitter.” It is reasonable therefore to nick the skin after the proprietary sheath is placed. The procedure is completed by release of the clip using a button “trigger.” In the CLIP trial, which compared the StarClose with manual compression, device success was 87%, with no difference in complications between the groups [29].

Figure 2.6 The StarClose device is delivered through a special sheath provided with the device. After the device is loaded into the artery, nitinol wings are opened within the artery and pulled back to capture the inner arterial wall. The clip device, shown on the left part of the figure, is then advanced to the outside surface of the artery. When a clip is fired, it inverts and the tines of the clip capture the arteriotomy and force it closed. This device is unique in that what is left behind is entirely extra‐arterial.

Figure 2.7 Femoral angiogram 1 year after closure with the StarClose device. The arrowhead on the left shows the device, and on the right contrast injection demonstrates the insertion site of the re‐puncture. The device is entirely extravascular.