Efficacy and safety of catheter‐based rheolytic and aspiration thrombectomy in children

Abstract

Catheter-based thrombectomy systems are an important adjunctive tool in the treatment of children with thrombotic vessel occlusions. Significant hemodynamic compromise seen when using AngioJet may be minimized by using activation times of ≤5 sec. © 2016 Wiley Periodicals, Inc.

Stent‐retriever thrombectomy in the treatment of infants with acute thrombosis of the superior vena cava and innominate vein

“…The combined approach resulted in further improvement of flow. This experience corresponds with data reported by Qureshi et al in a cohort of 21 patients who underwent aspiration thrombectomy for thrombosis of venous and arterial vessels . Thrombectomy alone did not usually result in sufficient patency of the affected vessel, particularly systemic veins.…”

“…Thrombectomy alone did not usually result in sufficient patency of the affected vessel, particularly systemic veins. Combination of aspiration thrombectomy with angioplasty, stent implantation or rtPA was successful in 16/18 patients who underwent this approach . Following subsequent treatment with low‐molecular‐weight heparin for 3 months, none of our patients developed rethrombosis.…”

“…The resulting sequelae including venous congestion, pleural effusions and chylothorax are associated with significant morbidity and mortality . Therapeutic options include local and systemic thrombolytic therapy, catheter aspiration thrombectomy, and surgery . In the last decade, interventional neuroradiologists have successfully introduced self‐expanding stent‐retriever systems for treatment of thromboembolic occlusion of major cerebral arteries in the context of acute ischemic stroke .…”

Pulmonary Embolism in Children

“…Suction embolectomy and thrombus fragmentation with rotation of a pigtail catheter or use of a balloon angioplasty catheter are also treatment modalities that are occasionally used in conjunction with USAT, rheolytic embolectomy, and rotational embolectomy. Perhaps the largest study in the pediatric population, studying 21 aspiration and rheolytic thrombectomies (5 of the pulmonary vasculature) at Texas Children's Hospital, showed that such interventions can be performed safely even in critically ill children with lifethreatening thrombosis (50).…”

Intra‐procedural continuous dialysis to facilitate interventional catheterization in pediatric patients with severe renal failure

“…Second, it allowed for prevention of serious electrolyte abnormalities such as hyperkalemia. In particular, procedures that cause hemolysis such as rheolytic thrombectomy using Angiojet, are known to potentially cause acute hyperkalemia even in patients with normal renal function , rendering this procedure particularly risky in the setting of dialysis‐dependent renal failure. Third, clearance of iodinated radiographic contrast was facilitated by the use of intra‐procedural dialysis.…”