Carotid artery cut-down technique for ductus arteriosus stenting

Area of Science:

• Pediatric Cardiology
• Interventional Cardiology
• Neonatal Surgery

Background:

• Ductal stenting is a critical intervention for neonates with congenital heart defects.
• Challenging ductal anatomy often necessitates alternative approaches.
• The carotid artery surgical cut-down technique is explored for neonates unsuitable for traditional femoral access.

Purpose of the Study:

• To evaluate the early and mid-term outcomes of ductal stenting using the carotid artery surgical cut-down technique in neonates.
• To assess the feasibility, safety, and efficacy of this approach in complex cases.

Main Methods:

• Retrospective analysis of 17 neonates undergoing ductal stenting via carotid artery cut-down between January 2015 and January 2022.
• Data collected included patient demographics, diagnoses, procedural success/failure, access-related complications, and neuroimaging findings.
• Primary indication was pulmonary atresia in all patients with challenging ductal anatomy unsuitable for femoral approach.

Main Results:

• Successful stenting was achieved in 15 out of 17 interventions (88.2%).
• No neurological or access-related complications were observed.
• Early in-hospital mortality was 17.6% (3/17); two patients with failed stenting underwent systemic-to-pulmonary shunt surgery.

Conclusions:

• Carotid artery cut-down for ductal stenting is feasible and safe in neonates, especially those with challenging ductal anatomy.
• This technique offers a potentially effective and less invasive alternative to systemic-to-pulmonary shunt operations.
• The findings support the use of carotid artery cut-down in select neonates requiring ductal stenting.