Neonatal PDA stent considerations: Retrospective review of anticoagulation, stent type, and PA jailing

The aim of this study is to evaluate the impact of anticoagulation strategy, stent type, and pulmonary artery (PA) jailing on unplanned reintervention rates and PA growth in neonates undergoing patent ductus arteriosus (PDA) stenting. Specifically, we compared aspirin monotherapy versus aspirin plus Enoxaparin, bare metal versus drug-eluting stents, and jailed versus non-jailed PAs.

A retrospective chart review was conducted on neonates who underwent PDA stenting between 2014 and 2024. Patients were categorized by stent type, anticoagulation regimen, and PA jailing status. Unplanned reintervention rates were assessed using chi-square analysis and logistic regression. PA growth was evaluated using catheterization, MRI, and CT imaging. Statistical analyses of PA growth included t-tests and regression models.

Among 116 neonates analyzed, aspirin monotherapy was associated with a significantly lower unplanned reintervention rate compared to combination therapy with Enoxaparin (p = 0.0447). Stent type did not significantly impact reintervention rates. Additionally, intrapatient jailed PAs exhibited significantly reduced distal growth compared to non-jailed PAs (p = 0.0070).

For neonatal PDA stenting, aspirin monotherapy may be as effective as aspirin plus Enoxaparin for post-stenting anticoagulation, and drug eluting stents may not have a significant benefit over bare metal stents. Furthermore, PA jailing may negatively impact distal vessel growth, highlighting the need for refined stent placement techniques, although further prospective studies are needed to optimize procedural strategies and long-term outcomes in this high-risk neonatal population.