Percutaneous carotid artery access in infants &lt; 3 months of age

Choudhry, Swati; Balzer, David T.; Murphy, James W.; Nicolas, Ramzi; Shahanavaz, Shabana

doi:10.1002/ccd.26310

Cited by 45 publications

(38 citation statements)

References 21 publications

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“…Hence, CA and even axillary artery (AA) access have been employed to place the PDA stent in some infants with this PDA anatomy. There are limited studies describing outcomes following surgical‐assisted or percutaneous CA access for neonatal interventions . These studies suggest that percutaneous CA is a safe alternative to traditional FA access, with a higher arterial patency rate post‐procedure compared with contemporary results from the FA .…”

Section: Introductionmentioning

confidence: 99%

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

Bauser‐Heaton

Qureshi

Goldstein

et al. 2019

Cathet Cardio Intervent

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Background Carotid artery (CA) and axillary artery (AA) access are increasingly used for transcatheter stenting of the patent ductus arteriosus (PDA), although reports are limited. Methods The Congenital Catheterization Research Collaborative (CCRC) reviewed multicenter data from infants who underwent PDA stenting via the CA or AA approach from 2008 to 2017, and compared outcomes to those of infants undergoing PDA stenting via the femoral artery (FA) approach. Post‐procedure ultrasound (US) imaging was reviewed. Results Forty‐nine infants underwent PDA stenting from the CA (n = 43) or AA (n = 6) approach, compared with 55 infants who underwent PDA stenting from the FA approach. The PDA was the sole pulmonary blood flow (PBF) source in 61% of infants in the CA/AA cohort, compared with 33% of the FA cohort (p < .01). Ductal tortuosity for CA/AA cohort was Type I (straight) in 10 (20%), Type II (one turn) in 17 (35%), and Type III (multiple turns) in 22 (45%) infants and reflected a greater degree of tortuosity when compared to the FA cohort (p < .01). In 17 infants with CA/AA approach, the “flip technique” was used, and was associated with shorter procedure times for highly tortuous PDA (Type III) patients. Rates of procedural complications were similar across access sites. Most common complications were access site injury (thrombus or bleeding) and stent malposition. No complications were specifically related to the “flip technique.” Conclusions Use of CA and AA approach for PDA stenting was found to be more commonly employed in sole source PBF and highly tortuous PDAs. Procedural modifications such as the “flip technique” may lead to shorter procedure times. CA and AA approaches are associated with a similar burden of procedural or late complications. Post‐procedural surveillance of the CA and AA is suggested, given the incidence of vascular findings on US.

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Section: Introductionmentioning

confidence: 99%

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

Bauser‐Heaton

Qureshi

Goldstein

et al. 2019

Cathet Cardio Intervent

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“…Previous reports have demonstrated that CA access in children for cardiac catheterization is safe . The patency rate immediately following CA access was reported in two separate studies to be >95%.…”

Section: Discussionmentioning

confidence: 91%

“…In that series 40/42 patients had a normal CA noted by ultrasound performed within 24 hr of PCA, with two cases of mild CA stenosis. Another study by Choudhry et al found that in infants <3 months of age, PCA was associated with favorable acute results . However, the late and midterm outcomes following PCA remain unreported.…”

Section: Introductionmentioning

confidence: 99%

Angiographic follow‐up of infants and children undergoing percutaneous carotid artery interventions

Ligon

Kim

Vincent

et al. 2018

Cathet Cardio Intervent

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PCA access for pediatric interventional catheterization appears to be safe with a very low rate of mild stenosis, and very few complications. Follow-up outcomes in our series are excellent, with a CA patency rate of 100%, even after multiple procedures. Mild CA stenosis was not associated with patient size or sheath introducer caliber. While the acute results from percutaneous CA catheterization have proven safe in recent literature, longer-term outcomes remain unreported. At our institution, the outcomes following percutaneous carotid access are associated with an excellent patency rate of 100%, even after multiple procedures on the same vessel. A low incidence of mild vessel stenosis can be appreciated on follow-up angiography.

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“…For PDAs that originate from the underside of the aortic arch (and some from the head/neck vessels), percutaneous axillary artery or common carotid artery access facilitates a direct and straight trajectory which allows for easier maneuverability of guidewires/stent systems. While previously axillary artery or common carotid artery access was performed via surgical cut down techniques, percutaneous axillary and percutaneous carotid artery access for PDA stenting has been shown to be safe and effective . We perform percutaneous axillary (Figure ) and percutaneous carotid artery (Figure ) access for these procedures with ultrasound guidance to ensure an isolated anterior wall puncture.…”

Section: Interventional Proceduresmentioning

confidence: 99%

Stenting of the ductus arteriosus for ductal-dependent pulmonary blood flow-current techniques and procedural considerations

Aggarwal

Petit

Glatz

et al. 2019

Congenital Heart Disease

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The use of prostaglandin‐E1 immediately after birth and subsequent surgical creation of the modified Blalock‐Taussig shunt (BTS) shunt have remarkably improved the prognosis and survival of children with congenital heart disease and ductal‐dependent pulmonary blood flow (PBF). Despite the advancement in surgical techniques, bypass strategies, and postoperative management, significant morbidity and mortality after BTS still remain. Patent ductus arteriosus stenting has been shown to be as an acceptable alternative to BTS placement in select infants with ductal‐dependent PBF. Newer procedural techniques and equipment, along with operator experience have all contributed to procedural refinement associated with improved outcomes over the recent years. In this article, we review the procedural and periprocedural details, with an emphasis on recent advances of this procedure.

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Percutaneous carotid artery access in infants < 3 months of age

Abstract: Our experience suggests that percutaneous CA access in infants <3 months of age is safe and feasible with preserved vascular patency and no neurological adverse events.

Cited by 45 publications

References 21 publications

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

Angiographic follow‐up of infants and children undergoing percutaneous carotid artery interventions

Stenting of the ductus arteriosus for ductal-dependent pulmonary blood flow-current techniques and procedural considerations

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