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Evaluation of carotid artery access in comparison with femoral artery access in neonatal percutaneous stenting of ductus arteriosus

Part of: Interventional Cardiology

Published online by Cambridge University Press:  18 February 2021

Gehan A. Alsawah ,
Hala Elmarsafawy Open the ORCID record for Hala Elmarsafawy [Opens in a new window] ,
Mona Hafez  and
Shaimaa Rakha Open the ORCID record for Shaimaa Rakha [Opens in a new window]
Gehan A. Alsawah
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Hala Elmarsafawy
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mona Hafez
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Shaimaa Rakha*
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*
Author for correspondence: Dr S. Rakha, MD, Pediatric Cardiology Unit, Mansoura University Children Hospital, El Gomhouria St, Mansoura, Dakahlia Governorate 35516, Egypt. Tel: +201030077567. E-mail: [email protected]
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Abstract

Background:

Patent ductus arteriosus stenting in duct-dependent pulmonary circulation is a challenging procedure. Percutaneous carotid artery access for ductal stenting has proven to be feasible; however, comparison with femoral artery access in terms of procedure details and complications either immediate or late is scarce. Therefore, we evaluated carotid artery access in comparison with femoral artery for stenting of patent ductus arteriosus.

Methods:

Forty neonates were reviewed, 20 were stented via carotid artery access, and 20 via the traditional femoral artery access. Comparison variables were neonatal demographics at the procedure, angiographic ductal anatomy, procedure details, and immediate complications. Follow-up Doppler ultrasound on access site was performed to document late complications.

Results:

Median age of included cases was 10.5 (3–28) days with complex ductal anatomy more frequently accessed via carotid artery than femoral. Immediate access-related complications were significantly higher with femoral than carotid artery access; 9 (45%) versus 3 (15%) respectively, p = 0.038. With carotid access, we had only one case with small pseudoaneurysm and acute hemiparesis 3 days after the procedure. Delayed local complications were more common with femoral access (15%) than carotid access (5%), mild stenosis in one case, and severe in another with femoral access; while with transcarotid arterial access, only one case had mild narrowing.

Conclusion:

Percutaneous carotid artery access in neonates is a more convenient approach for patent ductus arteriosus stenting especially with complex ductal anatomy. Moreover, local complications are limited and vascular patency is better preserved, in comparison with trans-femoral arterial access. However, the potential for neurological adverse events should not be overlooked.

Keywords

Carotid artery accesspercutaneousstentductus arteriosus
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 9 , September 2021 , pp. 1465 - 1471
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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