Angiographic follow‐up of infants and children undergoing percutaneous carotid artery interventions

Abstract

PCA access for pediatric interventional catheterization appears to be safe with a very low rate of mild stenosis, and very few complications. Follow-up outcomes in our series are excellent, with a CA patency rate of 100%, even after multiple procedures. Mild CA stenosis was not associated with patient size or sheath introducer caliber. While the acute results from percutaneous CA catheterization have proven safe in recent literature, longer-term outcomes remain unreported. At our institution, the outcomes following percutaneous carotid access are associated with an excellent patency rate of 100%, even after multiple procedures on the same vessel. A low incidence of mild vessel stenosis can be appreciated on follow-up angiography.

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

“…What is not known at this time is the long‐term effects of vascular access from the CA. Addressing this clinical question, Ligon et al reviewed all patients with midterm follow‐up CA imaging following percutaneous CA access . They found very low rates of mid‐term CA problems following percutaneous CA access, including a 35% incidence of mild, clinically silent, CA stenosis with a median stenosis of 4.1% as defined as narrowest diameter compared to nominal diameter.…”

Percutaneous intraluminal downsizing of systemic‐to‐pulmonary artery shunts: a novel application of the Diabolo stent technique—Case series and description of the technique

“…In small infants, the advancement of a 6 Fr long sheath from the femoral artery can be prohibitive and, more importantly, associated with serious complications and permanent pulse‐loss . In small case series, carotid‐artery access has been proposed as a possible alternative to femoral access with a low rate of complications . In particular, in patients with modified BT shunts, carotid access has the additional advantage of giving a straight pathway to access the shunt, making the delivery and manipulation of the stent technically less demanding .…”

“…In small case series, carotid‐artery access has been proposed as a possible alternative to femoral access with a low rate of complications . In particular, in patients with modified BT shunts, carotid access has the additional advantage of giving a straight pathway to access the shunt, making the delivery and manipulation of the stent technically less demanding . Therefore, in the smallest patient of the series, we elected to deliver the stent from the carotid artery to minimize the risk of injuring the femoral arteries, and we think that this approach should be taken into consideration for the management of patients with similar characteristics.…”

Transarterial and transvenous access for neurointerventional surgery: report of the SNIS Standards and Guidelines Committee

“…However, adopting ultrasound guided arterial puncture technique, systemic anticoagulation, and careful selection of catheter size have significantly reduced the femoral puncture site complication risks (<5%) 97–99. Umbilical artery access and carotid puncture have also been reported with reasonably low complication risks in limited circumstances 87 100…”