Format

Send to

Choose Destination
Catheter Cardiovasc Interv. 2019 Dec 1;94(7):989-995. doi: 10.1002/ccd.28486. Epub 2019 Aug 30.

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

Author information

1
Department of Pediatrics, University of Cincinnati College of Medicine, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
2
Department of Pediatrics, Baylor College of Medicine, Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, Texas.

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.

KEYWORDS:

Transcatheter; children; congenital heart disease; pediatrics; thrombus

PMID:
31471939
DOI:
10.1002/ccd.28486

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center