Utility of Post-Procedural Carotid Ultrasound Surveillance in Infants Undergoing Patent Ductus Arteriosus Stenting via Carotid Artery Access
Presenter
Eric Vincent Mittelstaedt, MD, Sanford Health, Sioux Falls, SD
Eric Vincent Mittelstaedt, MD1, Yousef Arar, M.D.2, Carrie Evans Herbert, M.D., FSCAI3, Suren Reddy, M.D.4, Thomas M. Zellers, M.D., FSCAI2 and Vasiliki Vivian Dimas, M.D., FSCAI3, (1)Sanford Health, Sioux Falls, SD, (2)The University of Texas Southwestern Medical Center, Dallas, TX, (3)Medical City Children’s Hospital, Dallas, TX, (4)UTSW Medical Center, Dallas, TX
Keywords: Complications, Imaging & Physiology and Vascular Access, Management, and Closure
Background
Common carotid artery (CCA) access has been used as a more direct route to the patent ductus arteriosus (PDA) for stenting procedures. Traditionally, surgical carotid artery cutdown (CAC) has been utilized. Recent literature suggests that percutaneous carotid access (PCA) may be a safe and effective alternative. However, access complications can be life threatening if not detected early. The aim of this study is to evaluate the utility of post-procedural carotid ultrasound (US) surveillance in patients (pts) undergoing PDA stenting.
Methods
A retrospective chart review of all infants undergoing PDA stenting via CCA access from September 2013 through December 2019 at our center was performed.
Results
33 pts underwent PDA stenting via CCA. PCA was utilized in 22 pts (66.6%). Median age was 7 days (range: 1 - 105 days) with median weight of 3 kg (range: 2 - 5.2 kg). Carotid US was performed post procedure in 21/22 PCA pts and 6/11 pts with CAC. 25/27 were performed within 24 hours. Prior to implementing routine US, one PCA pt was readmitted with a large pseudoaneurysm requiring urgent surgical repair. 17/21 pts with PCA had a normal US. One asymptomatic pt had an occlusive thrombus on US that was managed with heparin infusion and aspirin. Follow up US 6 months later showed non-occlusive thrombus. Other US abnormalities included subtle evidence of intimal injury (n=1) and focal stenosis (n=1) which were monitored (Figure 1). 5 pts (83%) with CAC had a normal US. One pt with CAC had a focal area of CCA stenosis which was monitored.
Conclusions
PCA is a safe alternative to CAC. Post-procedural carotid US surveillance aids in early identification of access complications.
