Initial experience with vascular plug devices for mechanical thrombectomy in symptomatic neonates and infants

Abstract

Objectives To describe a novel technique for mechanical thrombectomy (MT) in young children. Background Acute thrombosis in children may be a cause of significant morbidity or mortality. MT options in children are limited due to patient and vessel size, prompting consideration of innovative approaches. Methods Two‐center review of children with symptomatic non‐cerebral thrombotic vessel occlusion. A novel approach to MT was performed using a deployed but unreleased amplatzer vascular plug (AVP) to “scrape” the target vessel in retrograde fashion, thereby harvesting the thrombus via the access sheath. Results AVP‐MT was performed in four patients at a median age of 2 months (range: 1 day‐11 months) and median weight of 5.6 kg (1.8–10.9). In two cases, AVP‐MT was performed in isolation in neonates on cervical extracorporeal membrane oxygenation (ECMO) support with cannula‐associated obstructive aortic and brachiocephalic thrombus. AVP‐MT was also performed as adjunctive therapy in a patient with single ventricle physiology and pulmonary artery thrombosis and in an infant with mitral valve endocarditis and femoral arterial thromboembolism. In all cases, AVP‐MT was used to successfully remove thrombus from the target vessel and restore arterial flow, without procedural complications. Recurrent thrombosis occurred in both neonates, due to persistence of the ECMO cannula, with subsequent mortality. The other children were free of recurrent thrombus at 2 and 34 months. Conclusions Acute relief of symptomatic thrombosis may be achieved using AVP‐MT in small children, although thrombosis frequently recurs, and clinical prognosis may remain poor. This strategy should be considered when alternative MT treatment options are not applicable.

Transcatheter mechanical thrombectomy of neonatal occlusive aortic thrombus using an Amplatzer Piccolo PDA occluder

“…Transcatheter thrombectomy using the Amplatzer Vascular Plug II and IV has been described in four infants, where the technique to "scrape" the thrombus was well described. 9 Similarly, the use of a 54 mm Amplatzer Piccolo PDA occluder was described for successful removal of an abdominal aorta thrombus in a 5-month-old infant. 10 The benefit of this device is its softer design to prevent vascular injury associated with thrombectomy and the use of a very low-profile system (4-Fr).…”

Spontaneous neonatal pulmonary arterial thrombosis – cases, mechanisms, and literature review

“…2 Further, we felt that other reported techniques, such as using vascular plugs to extract the thrombus, had unpredictable risk of vascular damage given the location of this thrombus near the pulmonary artery bifurcation. 3 Left pulmonary artery angioplasty was performed using a 4-mm balloon with complete angiographic resolution of the obstruction and mild residual gradient ~15 mmHg (Fig. 1 and Videos 1-3).…”