Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Cardiol Young. 2021 Sep;31(9):1465-1471. doi: 10.1017/S1047951121000469. Epub 2021 Feb 18.
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.
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.
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.
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.
依赖动脉导管循环的动脉导管未闭支架置入术是一项具有挑战性的操作。经皮颈动脉入路用于导管支架置入已被证明是可行的；然而，关于手术细节和即刻或晚期并发症与股动脉入路的比较却很少。因此，我们评估了颈动脉入路与股动脉入路在动脉导管未闭支架置入中的应用。
回顾性分析了 40 例新生儿，其中 20 例经颈动脉入路，20 例经传统股动脉入路进行支架置入。比较变量包括手术时新生儿的人口统计学特征、血管造影导管解剖结构、手术细节和即刻并发症。对入路部位进行随访多普勒超声检查，以记录晚期并发症。
纳入病例的中位年龄为 10.5（3-28）天，复杂的导管解剖结构更常经颈动脉入路而不是股动脉入路。股动脉入路的即刻与入路相关的并发症显著高于颈动脉入路，分别为 9（45%）例和 3（15%）例，p=0.038。经颈动脉入路，我们只有 1 例术后 3 天出现小假性动脉瘤和急性偏瘫。股动脉入路的迟发性局部并发症更为常见（15%），而颈动脉入路的并发症更为常见（5%），1 例轻度狭窄，另 1 例严重狭窄；而经颈动脉入路，只有 1 例轻度狭窄。
经皮颈动脉入路在新生儿中是一种更为方便的动脉导管未闭支架置入术入路，特别是对于复杂的导管解剖结构。此外，与股动脉入路相比，局部并发症更为有限，血管通畅性更好。然而，不应忽视潜在的神经不良事件的可能性。
