MANTA vs Perclose for Large-Bore Femoral Closure in Impella-Assisted High-Risk Percutaneous Coronary Intervention - Retrospective Outcomes Study

Sep 29, 2026

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Retrospective outcomes study comparing vascular closure devices for large-bore femoral access in Impella-assisted high-risk percutaneous coronary intervention. Patients receiving either 14F MANTA or 14F Perclose were followed for vascular complications needing intervention, major bleeding by BARC type 3/5 criteria, and successful closure defined as hemostasis without further intervention or major bleeding. Perclose was commonly preclosed; Impella removal occurred in most cases at procedure end.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

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Background

Materials and methods

Results

Keywords and publication details

Journal of the Society for Cardiovascular Angiography & Interventions 4 (2025) 103943 Research Letter MANTA vs Perclose for Large-Bore Femoral Closure in Impella-Assisted High-Risk Percutaneous Coronary Intervention: Retrospective Outcomes Study Muhammad Memon, MD a, *, Raef Ali Fadel, DOb, Herbert D. Aronow, MD c, Ahmad Jabri, MD c, Mohammad Alqarqaz, MD c, Khaldoon Alaswad, MD c, Asaad Nakhle, MD c, Mir Babar Basir, DO c, Pedro Villablanca, MDd a Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan; b Division of Cardiology, Henry Ford Health System, Detroit, Michigan; c Interventional Cardiology, Henry Ford Health System, Detroit, Michigan; d Department of Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan Background Temporary mechanical circulatory support (tMCS) is frequently used in complex high-risk (HR) percutaneous coronary intervention (PCI), particularly in patients with severe ventricular dysfunction or extensive coronary disease. While the Impella percutaneous left ventricular assist device provides effective hemodynamic support during these procedures,1 device removal and closure of the large-bore arterial access site remain a key challenge, primarily due to risk of bleeding and other vascular access site complications.2 Vascular closure devices (VCDs) can facilitate achievement of hemostasis in this setting, with the most common being the suture-based Perclose3 and collagen plug–based MANTA closure devices.4 Despite widespread use, comparative data examining efficacy and vascular complications, especially in the context of Impella-assisted HR-PCI, remains limited.1 Device selection is often based on operator preference, vascular anatomy, and other patient-specific factors.5 We conducted a retrospective analysis at a tertiary high-volume center to evaluate VCD outcomes associated with MANTA vs Perclose in patients undergoing Impella-assisted HR-PCI. Materials and methods Our study included patients who underwent Impella-assisted HR-PCI from 2018-2023 at our center and received either a MANTA or a Perclose VCD as index closure device for hemostasis. Device choice was at operator discretion but informed by femoral angiography and ultrasound. No cases had dedicated computed tomography imaging before PCI. MANTA depth was consistently reported in every case of upfront MANTA use; all MANTA devices were of 14F. Only elective or staged HR-PCI cases were included. Patients presenting in cardiogenic shock were excluded. Most cases involving Perclose (82%) were preclosed with deployment of the Perclose device before insertion of a 14F Impella sheath. All Perclose cases involved 2-device preclosure. The Impella was removed at the end of the procedure in 78% of cases receiving MANTA closure and 80% of cases receiving Perclose. Patients were excluded if they died before Impella removal. If closure was delayed, a new MANTA device was used. Outcomes included, vascular complications requiring intervention, Bleeding Academic Research Consortium type 3 and type 5 major bleeding (defined by Bleeding Academic Research Consortium criteria), and successful closure (defined as hemostasis without need for further intervention or major bleeding) . Results A total of 145 patients were analyzed: 50 received MANTA (34 . 5%) and 95 received Perclose (65 . 5%) . Patients in the Perclose group were older (75.8 vs 71.1 years; P = .009), but other baseline factors such as peripheral artery disease (25.2%) and SYNTAX scores (~29) were similar. All patients had femoral Impella access, and none required escalation of tMCS intraprocedurally or postprocedurally. The Impella was removed at the end of the procedure in 78% of cases receiving MANTA closure and 80% of cases receiving Perclose. For cases receiving Perclose, 82% were deployed before implantation of the Impella (ie, preclose) . All cases receiving MANTA had reported MANTA depth before deployment for accur

FAQs

What was the study purpose comparing MANTA and Perclose in Impella-assisted high-risk PCI?

To evaluate vascular closure outcomes associated with MANTA versus Perclose in patients undergoing Impella-assisted high-risk percutaneous coronary intervention at a tertiary center.

How were endpoints and successful closure defined in the study?

Outcomes included vascular complications requiring intervention, major bleeding defined as BARC type 3 and type 5, and successful closure defined as hemostasis without need for further intervention or major bleeding.

How did Impella removal timing differ between MANTA and Perclose groups?

The Impella was removed at the end of the procedure in 78% of MANTA cases and 80% of Perclose cases.

Sep 29, 2026

Uploaded by Stanford