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Published on: February 18, 2020
Percutaneous stent implantation into coronary arteries in infants
András Bratincsák1, Anas Salkini, Howaida G El-Said
1Rady Children's Hospital, San Diego, California 92123, USA. bratiandris@yahoo.com
Insights
Percutaneous coronary intervention with stent implantation is a feasible and safe option for infants with coronary artery disease. This procedure can bridge young patients to surgery or transplantation, showing promising results in managing acute ischemia.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) is well-established in adults but rarely performed in infants.
- Coronary artery disease (CAD) and acute coronary syndrome (ACS) in infants present unique challenges.
Purpose of the Study:
- To assess the feasibility, techniques, safety, and potential of PCI and stent implantation in infants with CAD and ACS.
- To evaluate the efficacy of coronary artery stent implantation as a palliative measure in this population.
Main Methods:
- Retrospective review of pediatric patients undergoing PCI at Rady Children's Hospital-San Diego over 4 years.
- Analysis of procedural success, stent characteristics, and patient outcomes.
Main Results:
- Seven children, including four infants under 15 months, underwent successful coronary artery stent implantation.
- Excellent revascularization was achieved in all cases; bare metal stents (mean 2.5 mm diameter) were used.
- No in-stent restenosis or thrombosis occurred with stents >2.5 mm and dual anti-platelet therapy; average intervention-free period was 434 days.
Conclusions:
- Coronary artery stent implantation is a feasible and relatively safe palliative option for infants and toddlers with coronary stenosis.
- This strategy can bridge patients with acute ischemia or poor ventricular function to surgical revascularization or transplantation.
Objectives:
To investigate the feasibility, procedural techniques, safety, and overall potential of percutaneous coronary angioplasty and stent implantation in infants with coronary artery disease and acute coronary syndrome.
Background:
Despite extensive experience in adult patients, percutaneous coronary intervention remains uncommon in children and extremely rare in infants.
Methods:
Retrospective review including all children who underwent percutaneous coronary angioplasty in Rady Children's Hospital-San Diego during a period of 4 years.
Results:
Seven children including four children less than 15 months of age underwent percutaneous coronary intervention with coronary stent implantation in the proximal portion of the left or right coronary arteries. Successful stent placement with excellent revascularization was achieved in all cases. Mean coronary artery diameter was 0.65 mm prior to stent placement. Balloon angioplasty resulted in suboptimal resolution of coronary stenosis, thus bare metal stents were implanted in all cases, dilated to a mean of 2.5-mm internal diameter. Average intervention-free period was 434 days after stent implantation. In-stent re-stenosis and stent thrombosis did not occur if the implanted stent diameter was greater than 2.5 mm and the patient received dual anti-platelet therapy.
Conclusions:
Our experience suggests that coronary artery stent implantation is a feasible and relatively safe palliative option in infants and toddlers with coronary stenosis. It is a viable strategy for bridging patients with acute ischemia or poor ventricular function to elective surgical revascularization or transplantation.
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