Novel use of Vascular Plug Devices for Mechanical Thrombectomy in Infants with Symptomatic Acute Thrombosis

Background
Acute thrombosis in infants may be a cause of significant morbidity or mortality. Mechanical thrombectomy (MT) options in infants are limited due to patient and vessel size, prompting consideration of innovative approaches.

Methods
A two center review of infants with symptomatic non-cerebral thrombotic vessel occlusion. A novel approach to MT was performed using a deployed but unreleased Amplatzer Vascular Plug (AVP) to “scrape” the target vessel in retrograde fashion, thereby harvesting the thrombus via the access sheath.

Results
AVP-MT was performed in 4 patients at a median age of 2 (range 0.1 - 11) months and weight of 5.6 (1.8 - 10.9) kg. In 2 cases, AVP-MT was performed in isolation in neonates on cervical ECMO support with cannula-related obstructive aortic and brachiocephalic thrombus (Figure 1A & C; arrows depict thrombus +/- vascular occlusion). AVP-MT was performed as adjunctive therapy in a patient with single ventricle physiology and pulmonary artery thrombosis and in an infant with mitral valve endocarditis and femoral arterial thromboembolism. In all cases, AVP-MT was used to successfully remove thrombus from the target vessel and restore unobstructed flow (Figure 1B & D). There were no procedural complications. Recurrent thrombosis occurred in both neonates, due to persistence of the ECMO cannula, with subsequent mortality. The other infants were free of recurrent thrombus at 2 and 34 months.

Conclusions
Acute symptomatic thrombosis may be effectively and safely treated using AVP-MT in infants. This strategy should be considered when alternative MT treatment options are not applicable.