MynxGrip vascular closure device use in pediatric neurointerventional procedures

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The aim of this paper was assess the efficacy and safety of using the MynxGrip arterial closure device in pediatric neuroendovascular procedures where the use of closure devices remains off-label despite their validation and widespread use in adults.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A retrospective review of all pediatric patients who underwent diagnostic or interventional neuroendovascular procedures at the authors’ institution was performed. MynxGrip use was predicated by an adequate depth of subcutaneous tissue and common femoral artery (CFA) diameter. Patients remained on supine bedrest for 2 hours after diagnostic procedures and for 3 hours after therapeutic procedures. Patient demographics, procedural details, hemostasis status, and complications were recorded.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Over 36 months, 83 MynxGrip devices were deployed in 53 patients (23 male and 30 female patients; mean age 14 years) who underwent neuroendovascular procedures. The right-side CFA was the main point of access for most procedures. The mean CFA diameter was 6.24 mm and ranged from 4 mm to 8.5 mm. Diagnostic angiography comprised 46% of the procedures. A single device failure occurred without any sequelae; the device was extracted, and hemostasis was achieved by manual compression with the placement of a Safeguard compression device. No other immediate or delayed major complications were recorded.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>MynxGrip can be used safely in the pediatric population for effective hemostasis and has the advantage of earlier mobilization.</jats:p></jats:sec>

Pediatric diagnostic cerebral angiography: practice recommendations from the SNIS Pediatric Committee

“…If use of a vascular closure device is planned, one may consider devices that achieve hemostasis without leaving an indwelling intra-vascular component. 33 In small children, attention must be paid to avoid sustained…”

Transarterial and transvenous access for neurointerventional surgery: report of the SNIS Standards and Guidelines Committee

“…Puncture site closure device applications such as Angioseal (St Jude Medical) and MynxGrip (Cordis) have been reported off-label in selected patients (CFA diameter >4 mm). However, such devices are approved by the Food and Drug Administration only for patients aged 18 years and over 106 107. Use of closure devices may potentially decrease immobilization time, decrease the length of hospital stay, and possibly reduce the risk of rebleeding, considering the low compliance of the pediatric cohort 106.…”

“…However, such devices are approved by the Food and Drug Administration only for patients aged 18 years and over 106 107. Use of closure devices may potentially decrease immobilization time, decrease the length of hospital stay, and possibly reduce the risk of rebleeding, considering the low compliance of the pediatric cohort 106. However, its use must be carefully tailored considering the risk benefit ratio in each pediatric patient, particularly when considering the off-label nature of use.…”