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Evolving use of embolisation coils for occlusion of the arterial duct
E Rosenthal1, S A Qureshi, J Reidy
1Department of Paediatric Cardiology, Guy's Hospital, London.
Insights
Coil occlusion of arterial ducts is effective, achieving a 93% closure rate within one year. This method, tailored to duct anatomy, offers practical and cost benefits for pediatric cardiology.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect.
- Transcatheter coil occlusion is an alternative to surgical ligation.
- Optimizing coil selection based on duct morphology is crucial for successful occlusion.
Purpose of the Study:
- To evaluate the efficacy and outcomes of transcatheter arterial duct occlusion using coils.
- To assess the impact of coil selection based on ductal anatomy.
- To determine the occlusion rates and complication profile of coil embolization in pediatric patients.
Main Methods:
- Retrospective analysis of 57 pediatric patients (0.5-15 years) undergoing coil occlusion.
- Utilized four types of coils (Platinum, Interlocking Detachable, Gianturco, PDA controlled release) based on duct morphology.
- Implantation via 4 or 5 F femoral artery catheters.
Main Results:
- Successful coil implantation in 54/57 patients (95%).
- Cumulative 1-year occlusion rate of 93% (53/57 ducts).
- Coil embolization occurred in 6% of procedures, with all embolized coils easily retrieved.
Conclusions:
- Coil occlusion is a readily accomplished and effective method for small to moderate arterial ducts.
- Tailoring coil selection to duct anatomy ensures high success rates.
- This technique offers significant cost and practical advantages in pediatric cardiac interventions.
Objective:
To assess the outcome of arterial duct occlusion with coils chosen according to the duct morphology.
Design:
Retrospective study.
Setting:
Paediatric cardiology centre.
Patients:
Coil occlusion was attempted in 57 patients aged 0.5 to 15 (median 3.7) years and weighing 5-59 (median 14) kg between January 1991 and December 1995. A residual leak was present in 8 patients after umbrella closure and in 4 patients after duct ligation.
Methods:
Coils of 4 different types were implanted through 4 or 5 F femoral artery catheters. Platinum or Interlocking Detachable 0.018 inch coils were deployed completely inside tubular ducts. Gianturco or PDA controlled release 0.038 inch coils were implanted to straddle short, post ligation and post umbrella ducts.
Results:
Coil implantation was successful in 54/57 patients. At 1 year the cumulative occlusion rate was 53/57 ducts (93%) on an intention to treat analysis. A single coil was implanted in 37 (69%), 2 coils in 10 (19%), 3 coils in 3 (5%) and 4 coils in 4 (7%) of the 54 successful procedures. Duct occlusion was documented at the end of the procedure in 31%, by the following day in 83%, by 6 weeks in 87%, by 6 months in 96%, and by 1 year in 98%. Coil embolisation occurred in 6/58 procedures (10%), with a 50% rate in the first year of implantation (1/2 patients) falling to 7% in the last year (3/42 patients). All embolised coils were easily retrieved.
Conclusions:
Occlusion of small to moderate size arterial ducts, including residual post umbrella or post ligation ducts, was readily accomplished by coils selected according to the duct anatomy. This has both cost and practical benefits.