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Angiographic follow-up of infants and children undergoing percutaneous carotid artery interventions
R Allen Ligon1, Dennis W Kim1, Robert N Vincent1
1Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Insights
Percutaneous carotid arterial (PCA) access for pediatric heart procedures is safe, with a very low rate of mild stenosis and excellent long-term vessel patency. This study found no significant risk factors for stenosis, even after multiple procedures.
Area of Science:
- Pediatric Cardiology
- Interventional Radiology
- Vascular Access
Background:
- Percutaneous carotid arterial (PCA) access is increasingly used in pediatric cardiology as a safe alternative to surgical cutdown or femoral access.
- However, long-term follow-up outcomes after PCA remain largely unreported in the literature.
Purpose of the Study:
- To review the outcomes of percutaneous carotid arterial access in infants and children with congenital heart disease.
- To assess the incidence of carotid artery stenosis and other complications following PCA.
Main Methods:
- Retrospective review of 61 PCA catheterizations in 55 pediatric patients with congenital heart disease between May 2012 and December 2016.
- Follow-up carotid artery (CA) angiography was performed to evaluate for stenosis and complications.
Main Results:
- Follow-up angiography was available in 78% of patients (43/55).
- No significant vessel stenosis or lumen irregularity was observed in 65% of patients.
- Mild stenosis (median 4.1%) was noted in 35% of cases, with no identified risk factors.
- Carotid artery patency remained 100% even in patients undergoing repeat PCA procedures.
Conclusions:
- Percutaneous carotid arterial access is a safe approach for pediatric interventional catheterization with a low incidence of mild stenosis and minimal complications.
- Excellent long-term carotid artery patency (100%) was demonstrated, even after multiple procedures, supporting PCA as a viable vascular access route.
Objective:
The purpose of this study was to review the outcomes following the percutaneous carotid arterial (PCA) approach in infants and children with congenital heart disease.
Background:
PCA access is becoming more commonly adopted following reports demonstrating it is a safe alternative to surgical carotid cutdown and even the femoral arterial route. However, follow-up outcomes after PCA remain unreported.
Methods:
We reviewed all cases with PCA access and follow-up catheterizations which included carotid artery (CA) angiography between May 2012 until December 2016. We examined for evidence of CA stenosis at follow-up angiography and assessed any other CA complications associated with vascular access.
Results:
There were 61 PCA catheterizations performed in 55 unique patients. Follow-up CA imaging with angiography was available in 43 patients (78%, 43/55). There was no vessel stenosis nor lumen irregularity in 28 (65%) patients. In 15 cases (35%), there was a mild degree of irregularity or narrowing by angiography (median 4.1%, range 2.3%-12.5%). Nine patients underwent repeat PCA catheterizations. Seven of these had no visible vascular stenosis on follow-up angiographic imaging, including a patient who was accessed three separate times from the CA. No statistically significant risk factors for developing mild CA stenosis were identified.
Conclusions:
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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