Title
Various applications of the Indigo
TM aspiration system for catheter-based mechanical thrombectomy in the pediatric setting.
Introduction:
The Penumbra Indigo
TM aspiration system is an endovascular mechanical thrombectomy device that is comprised of a continuous aspiration source attached to aspiration catheters (CAT). We describe four separate cases where novel use of this system allowed safe and effective removal of thrombi in three patients with congenital heart disease and another patient with a recurrent, complex pericardial effusion.
Clinical Case:
Case 1 A 53-day-old girl with absent right atrio-ventricular (AV) connection, malposed great vessels and pulmonary atresia underwent placement of a central shunt at 6 days of life. A CTA performed for progressive desaturation demonstrated near complete occlusion of her left pulmonary artery (LPA). Angiography demonstrated non-occlusive thrombus in the distal shunt and confirmed complete LPA occlusion. The Indigo
TM system was used to remove the shunt and LPA thrombosis allowing placement of an LPA stent. Subsequent angiography showed a widely patient central shunt and LPA.
Case 2 A 22-year-old man with tricuspid atresia and failing Fontan physiology was found to have an extensive non-occlusive thrombus involving the distal IVC. An IVC filter was placed via RIJ approach by interventional radiology distal to the IVC thrombus. The Indigo
TM system was then used to remove thrombus with good long-term results.
Case 3 An 8-month-old girl with d-TGA, VSD and pulmonary stenosis following Nikaidoh procedure developed acute decompensation and worsening heart function requiring VA ECMO cannulation. She was taken to the cath lab for coronary evaluation due to concern for coronary hypoperfusion. Angiography revealed a thrombus in the non-coronary cusp. The Indigo
TM system was used to remove thrombus. No neurologic sequelae were noted at 4 months post-procedure.
Case 4 A 4-year-old boy presented with a recurrent complex pericardial effusion secondary to karposiform lymphangiomatosis (KLA). Due to extensive loculation, conventional drainage was ineffective. The Indigo
TM system was used to remove thrombus within the pericardial space. Our patient had good medium-term results with complete resolution of his pericardial effusion at 4 months.
Discussion
We describe different uses for the Indigo
TM aspiration system in removal of thrombus in four separate, complex patients. The Indigo
TM aspiration system allows direct removal of thrombus without the risks associated with surgery, systemic thrombolytic therapy or other anticoagulation strategies. Studies demonstrating its benefit outside of its use in the management of pulmonary embolism and peripheral arterial and venous thrombi in adults are limited. These cases demonstrate that the Indigo
TM aspiration system can be a safe and effective alternative for catheter-based mechanical thrombectomy.