Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T13:39:21.079Z Has data issue: false hasContentIssue false
  • English
  • Français

Hybrid stenting of the arterial duct with carotid cutdown and flip technique: immediate and early results

Part of: Interventional Cardiology

Published online by Cambridge University Press:  11 October 2021

Supratim Sen Open the ORCID record for Supratim Sen [Opens in a new window] ,
Priya Pradhan ,
Sneha Jain Open the ORCID record for Sneha Jain [Opens in a new window] ,
Dipesh Trivedi  and
Pradeep Kaushik
Supratim Sen*
Affiliation:
Department of Pediatric Cardiology, SRCC Children’s Hospital, Mumbai, India
Priya Pradhan
Affiliation:
Department of Pediatric Cardiology, SRCC Children’s Hospital, Mumbai, India
Sneha Jain
Affiliation:
Department of Pediatric Cardiology, SRCC Children’s Hospital, Mumbai, India
Dipesh Trivedi
Affiliation:
Department of Pediatric Cardiac Surgery, SRCC Children’s Hospital, Mumbai, India
Pradeep Kaushik
Affiliation:
Department of Pediatric Cardiac Surgery, SRCC Children’s Hospital, Mumbai, India
*
Author for correspondence: Dr S. Sen, Department of Pediatric Cardiology, SRCC Children’s Hospital, Mahalaxmi, Mumbai400050, India. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Stenting of the arterial duct (PDA) has become a standard palliation for ductal-dependent pulmonary circulation. Carotid arterial access provides a direct route for stenting vertical ducts. We evaluated our early results of hybrid ductal stenting via surgical carotid cutdown.

Methods and results:

In this retrospective single centre cohort study, hybrid PDA stenting was attempted in 11 patients with “flip technique”, between January 2020 and February 2021, and was successful in 10. Median age was 29 days (interquartile range 17.5–87) and mean weight 3.37 ± 1.23 kg. Mean fluoroscopy time was 13.58 ± 5.35 minutes, mean procedure time was 48.50 ± 22.5 minutes, and mean radiation dose was 1719.5 ± 1217.6 mGycm2. Mean time for cutdown was 9.9 ± 2.4 minutes and for haemostasis and suturing was 25.3 ± 11.0 minutes. Median duration of ventilation post-stenting was 26 hours (interquartile range 21–43.75). The median ICU stay post-procedure was 5 days (interquartile range 4–7.25) and mean hospital stay was 12 ± 6.3 days. On early follow-up, carotid patency was confirmed in all patients with colour Doppler, with no intravascular thrombi, narrowing, haematomas, or aneurysms noted. There were no complications secondary to vascular access. There was one early mortality, 27 days post-stenting, which was unrelated to the procedure.

Conclusion:

This study adds to the limited literature on ductal stenting with carotid access and the flip technique. In our early experience, the hybrid carotid approach is an attractive alternative to percutaneous carotid puncture and has simplified a complex and challenging intervention, with good outcomes.

Keywords

PDA stentingcarotid cutdownpulmonary atresianeonatal interventions
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 8 , August 2022 , pp. 1254 - 1260
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bentham, JR, Zava, NK, Harrison, WJ, et al. Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation 2018; 137: 581–588. DOI 10.1161/CIRCULATIONAHA.117.028972.CrossRefGoogle Scholar
Glatz, AC, Petit, CJ, Goldstein, BH, et al. Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the congenital catheterization research collaborative. Circulation 2018; 137: 589–601. DOI 10.1161/CIRCULATIONAHA.117.029987.CrossRefGoogle ScholarPubMed
Justino, H, Petit, CJ. Percutaneous common carotid artery access for pediatric interventional cardiac catheterization. Circ Cardiovasc Interv 2016; 9: e003003. DOI 10.1161/CIRCINTERVENTIONS.115.003003.CrossRefGoogle ScholarPubMed
Alwi, M. Stenting the ductus arteriosus: case selection, technique and possible complications. Ann Pediatr Cardiol 2008; 1: 38–45. DOI 10.4103/0974-2069.41054.CrossRefGoogle ScholarPubMed
Bauser-Heaton, H, Qureshi, AM, Goldstein, BH, Glatz, AC, Petit, CJ. Use of novel "Flip technique" aids in percutaneous carotid artery approach in neonates. JACC Cardiovasc Interv 2019; 12: 1630–1631. DOI 10.1016/j.jcin.2019.04.053.CrossRefGoogle ScholarPubMed
Qureshi, AM, Goldstein, BH, Glatz, AC, et al. Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting. Catheter Cardiovasc Interv 2019; 93: 933–943. DOI 10.1002/ccd.28125.CrossRefGoogle ScholarPubMed
Sivakumar, K. PDA stenting in duct-dependent pulmonary circulation. In: Butera, G, et al. (eds). Cardiac Catheterization for Congenital Heart Disease: From Fetal Life to Adulthood. Springer-Verlag Italia, Milan, 2015: 375–399. DOI 10.1007/978-88-470-5681-7_24.Google Scholar
Breatnach, CR, Aggarwal, V, Al-Alawi, K, et al. Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period. Catheter Cardiovasc Interv 2019; 93: 1329–1335. DOI 10.1002/ccd.28302.Google ScholarPubMed
Choudhry, S, Balzer, D, Murphy, J, Nicolas, R, Shahanavaz, S. Percutaneous carotid artery access in infants <3 months of age. Catheter Cardiovasc Interv 2016; 87: 757–761. DOI 10.1002/ccd.26310.CrossRefGoogle ScholarPubMed
Polat, TB. Use of percutaneous carotid artery access for performing pediatric cardiac interventions: Single-center study. Ann Pediatr Cardiol 2020; 13: 16–24. DOI 10.4103/apc.APC_26_19.CrossRefGoogle ScholarPubMed
Fischer, DR, Ettedgui, JA, Park, SC, Siewers, RD, del Nido, PJ. Carotid artery approach for balloon dilation of aortic valve stenosis in the neonate: a preliminary report. J Am Coll Cardiol 1990; 15: 1633–1636. DOI 10.1016/0735-1097(90)92839-t.CrossRefGoogle ScholarPubMed
Maeno, Y, Akagi, T, Hashino, K, et al. Carotid artery approach to balloon aortic valvuloplasty in infants with critical aortic valve stenosis. Pediatr Cardiol 1997; 18: 288–291. DOI 10.1007/s002469900176.CrossRefGoogle ScholarPubMed
Robinson, BV, Brzezinska-Rajszys, G, Weber, HS, et al. Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry. Cardiol Young 2000; 10: 225–232. DOI 10.1017/s104795110000915x.CrossRefGoogle ScholarPubMed