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This article addresses the utility of Angio-Seal versus manual hemostasis in anticoagulated patients following neurointerventional procedures. In a study of 174 punctures, 104 were closed with Angio-Seal and the rest with manual compression. All patients had activated clotting time values between 250–500 seconds at the time of closure. Mean hemostasis times were significantly longer with manual compression and hematomas 3 times more common. Using Angio-Seal led to arterial occlusion in 1 patient who was successfully revascularized. Thus, Angio-Seal is fast and effective in this setting.

The authors used the Pipeline device to treat 20 patients with acutely ruptured intracranial aneurysms. The most common types of aneurysms treated were blister and dysplastic/dissecting. Procedure-related morbidity/mortality overall was 15%, and 1 death directly related to the procedure occurred. Occlusion rates were 75% and 94% at 6 months and 12 months, respectively. The authors concluded that the Pipeline device offers a feasible treatment option in acute or subacute ruptured aneurysms, especially the blister type. Ruptured giant aneurysms remain challenging for both surgical and endovascular techniques; at this stage, the Pipeline device should be used with caution in this aneurysm subtype.