OR01-5
Pre-Catheterization CT Scanning Aids in the Selection of PDA Stent Length for Ductal Dependent Pulmonary Blood Flow
Presenter
Wadsworth Williams, M.D., Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
Wadsworth Williams, M.D., Matthew Cornicelli, M.D., Nazia Husain, M.D., Jeremy Fox, M.D., Alan W. Nugent, M.B.B.S., Dr. Paul Tannous, M.D., Ph.D. and Conor O'Halloran, M.D., Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
Keywords: Imaging & Physiology and Patent Ductus Arteriosus (PDA)
Background:
PDA stenting for ductal dependent pulmonary blood flow is increasingly utilized. Predicting optimal stent length prior to intervention remains a challenge. We evaluated the utility of pre-catheterization computed tomography angiography (CTA) for this purpose.
Methods:
All patients that received a PDA stent for pulmonary blood flow between 2019-2022 with a pre-stent CTA were reviewed. Several CTA and catheter angiography-based measurements of the native and stented PDA were performed. The stented ductal length (SDL) was determined by catheter angiography after stent deployment by subtracting the aortic and pulmonary overhang from the total stent length. Curvilinear and straight-line PDA lengths were determined by pre-catheterization CTA and used to calculate the tortuosity index ([Curvilinear-Straight]/Curvilinear). A linear regression model was created using an Akaike information criteria (AIC) analysis to identify CTA measurements that correlate with SDL.
Results:
31 patients met inclusion criteria. The SDL lies between the pre-stent CTA straight length and curvilinear length for most patients (Figure 1). As the PDA tortuosity index increases, the curvilinear length increases exponentially, while the SDL remains closer to the straight length. From our AIC analysis, only CTA straight length was significantly associated with SDL. Linear regression modelling predicts that the SDL is 1.13 times the CTA straight length (R2=0.97, p<0.001).
Conclusions:
Pre-intervention CTA can aid in the selection of PDA stent length prior to catheterization. The SDL is well approximated by the pre-stent CTA straight length with a small correction. 