Use of preformed nitinol snare to improve transcatheter coil delivery in occlusion of patent ductus arteriosus

doi:10.1016/0002-9149(94)90451-0

The American Journal of Cardiology

Volume 74, Issue 8, 15 October 1994, Pages 836-839

https://doi.org/10.1016/0002-9149(94)90451-0 Get rights and content

Abstract

Recent studies have reported the efficacy of transcatheter occlusion of the small patent ductus arteriosus (PDA) using a Gianturco Coil^1–3 as an alternative to either surgery or Rashkind Umbrella placement.⁴ This report presents our experience using a preformed nitinol snare, delivered via the venous circulation, to hold and manipulate the coil as it is delivered from the arterial side of the PDA. This modification was designed to aid in the positioning of the coil, and to facilitate coil retrieval in the event of unstable or unfavorable position after delivery.

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Cited by (107)

Outcomes of transcatheter occlusion of patent ductus arteriosus in infants weighing ≤6 kg
2010, JACC: Cardiovascular Interventions
Citation Excerpt :
Transcatheter closure of PDAs is rapidly becoming the treatment of choice at most centers in larger infants, children, and adults. Since the initial descriptions of PDA closure with Gianturco coils, there have been various techniques for coil delivery reported to achieve greater coil stability during closure (4–6). The most frequent complication using Gianturco coils has been coil embolization in up to 10% of cases (7).
We sought to analyze the outcomes of transcatheter patent ductus arteriosus (PDA) occlusion using a variety of devices in infants weighing ≤6 kg.
Indications for transcatheter closure of a PDA in infancy include congestive heart failure and/or failure to thrive. Devices available for small infants may be problematic for various reasons, including sheath size, stiffness of delivery system, and anchoring and retrievability characteristics of the device. The Amplatzer Ductal Occluder is approved by U.S. Food and Drug Administration for children weighing >6 kg and older than 6 months of age.
We performed a multicenter, retrospective analysis of children weighing ≤6 kg in whom transcatheter PDA occlusion was attempted between January 1995 and November 2005 at Texas Children's Hospital and January 2001 to November 2005 at Children's Hospital of San Diego.
A total of 62 patients underwent attempted closure. The mean age at catheterization was 4.7 ± 2.8 months with a mean weight at catheterization of 4.6 ± 0.9 kg. Successful device placement was achieved in 58 of 62 patients (94%). Among those receiving a device, complete occlusion was noted in all 58 patients at either catheterization or last available follow-up.
Percutaneous closure of PDA should be considered even in infants ≤6 kg.
Outcome of percutaneous transarterial coil occlusion in patients with isolated patent ductus arteriosus using an upstream-and-push maneuver
2006, Journal of the Formosan Medical Association
There are limited data on the outcome of percutaneous transarterial coil occlusion for isolated patent ductus arteriosus (PDA) in Taiwan. This study evaluated the 2-year outcome of 52 patients with isolated PDA who received percutaneous transarterial coil occlusion by an upstream-and-push maneuver.
From July 1997 to June 2002, a total of 52 patients (25 infants, 27 children) underwent occlusion of PDA with standard Gianturco coils. There were 39 females and 13 males. Patient age ranged between 7 days and 14 years, and weight was between 3 and 45 kg. Percutaneous transarterial coil occlusion was performed by an upstream-and-push maneuver. Chest auscultations, chest radiographs, and Doppler echocardiography were performed in all patients within 24 hours, and 1, 3, 6, 12 and 24 months after coil occlusion.
Mean PDA diameter at the pulmonary end was 2.34 ± 1.00 mm (range, 1.00-4.80 mm). Angio-graphic classification was megaphone type in 32 patients, window type in seven, tubular type in six, an-eurysmal type in three, and elongated conical type in four. Complete PDA occlusion was performed with a single coil in 41 (79%) patients and with multiple coils in 11 (21%). The mean ratio of pulmonary to systemic blood flow was 1.95 ± 0.95 (range, 1.10-5.80) before the procedure, and 1.02 ± 0.04 (range, 1.00-1.20) after the procedure (p < 0.001). Immediate occlusion of the ductus was achieved 15 minutes after the procedure in 44 (85%) patients. Occlusion was achieved in 92% of patients within 24 hours and in 100% of patients by the 1-month follow-up. Follow-up at 24 months after the procedure revealed no complications.
Percutaneous transarterial coil occlusion with 5-loop Gianturco coils can be effectively and safely achieved in patients with a PDA minimum diameter < 5 mm.
Multicenter USA amplatzer patent ductus arteriosus occlusion device trial: Initial and one-year results
2004, Journal of the American College of Cardiology
Citation Excerpt :
This group had a morbidity rate of 4.4%, an average length of stay of 2.8 days, and 0% mortality. In recent decades, efforts to perfect a transcatheter approach to ductal closure have been extensive, and there have been a number of methods suggested, including the Portsmann plug, Rashkind device, and, more recently, Gianturco embolization coils (1–12). The major goal of all of these efforts has clearly been to avoid surgery and its rare but significant attendant risks.
We sought to review and report initial and one-year efficacy and safety results of the multicenter USA Amplatzer ductal occluder (ADO) device trial.
Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using conventional techniques is challenging. The ADO can close a PDA up to 12 mm in diameter.
From September 1999 to June 2002, 484 patients were enrolled in 25 U.S. centers. Forty-five (9%) of 484 patients did not have ADO implantation, because the PDA was too small or because of elevated pulmonary resistance. The median age of the patients at catheterization was 1.8 years (range 0.2 to 70.7 years), and weight was 11 kg (range 4.5 to 164.5 kg).
The median PDA minimal diameter was 2.6 mm (range 0.9 to 11.2 mm); 76 (17%) of 439 were larger than 4.0 mm. Median pulmonary artery mean pressure was 20 mm Hg (range 7 to 80 mm Hg). The ADO was implanted successfully in 435 (99%) of 439 patients, with a median fluoroscopy time of 7.1 min (range 2.9 to 138.4 min). Angiographic demonstration of occlusion was seen in 329 (76%) of 435. This increased to 384 (89%) of 433 on post-catheterization day 1, with occlusion documented in 359 (99.7%) of 360 at one year. At the last evaluation in all patients at any time, PDA closure was documented in 428 (98%) of 435 patients. There have been two cases of partial left pulmonary artery occlusion after ADO implantation and no cases of significant aortic obstruction.
Moderate to large PDAs can be effectively and safely closed using the ADO device, with excellent initial and one-year results. This device should obviate the need for multiple coils or surgical intervention for these defects.
Interventional catheter therapy in adults with congenital heart disease
2003, Progress in Pediatric Cardiology
Early reopening and recanalization after successful coil occlusion of the patent ductus arteriosus
2002, American Heart Journal
Citation Excerpt :
However, 0.038-inch or 0.052-inch Gianturco coils (Cook Inc) were used in most patients. Coils were delivered retrograde with the freehand2 or snare techniques12,13 or antegrade with the bioptome technique.14,15 If greater than a trivial shunt was present on the postcoil aortogram, additional coil placement was attempted.
Background Controversy exists regarding early reopening and recanalization after successful (complete) coil occlusion of the patent ductus arteriosus (PDA). Methods Patients with successful PDA coil occlusion were reviewed with regard to PDA size and type, coil size, number of coils, and delivery technique. Follow-up echocardiograms at <24 hours, 6 months, and >12 months were reviewed for residual PDA shunt, left pulmonary artery (LPA) stenosis, and aortic obstruction. Results Successful coil occlusion was achieved in 94 patients. On the initial (<24 hours) echocardiogram, 76 of 92 (83%) had complete PDA occlusion, 5 of 92 (5%) had mild LPA stenosis, and no patient had aortic obstruction. Follow-up at 6 months was available in 70 patients, 57 with complete occlusion on the initial echocardiogram. PDA reopening was found in 3 of 57 patients (5%). Larger PDA diameter was associated with residual shunt (2.40 ± 0.40 mm versus 1.87 ± 0.53 mm; P <.01). Disagreement between the initial and 6-month echocardiogram was found in 11 of 70 patients (16%). Intermediate follow-up (median, 30 months; range, 12 months to 5.3 years) was available in 46 patients, 38 with complete occlusion on the 6-month echocardiogram. No patient (0 of 38) with a normal echocardiogram at 6 months developed recanalization, LPA stenosis, or aortic obstruction. Conclusion These data suggest that: (1) routine echocardiography immediately after PDA coil occlusion is unnecessary; (2) early PDA reopening is uncommon; and (3) PDA recanalization does not occur if complete echocardiographic closure is documented 6 months after coil occlusion. Additional follow-up examination in these patients may not be necessary. (Am Heart J 2002;143:889-93.)
Experimental evaluation of a new transcatheter vascular embolization device in the swine model
2002, Journal of Vascular and Interventional Radiology
To evaluate a new transcatheter device suitable for arterial embolization in an animal model.
A new prototype self-expanding braided embolic device (Embolizor), consisting of nitinol wire strands fixed at either end with platinum-iridium bands and covered with a film of polyethylene, was deployed through 5-F diagnostic catheters into renal artery branches in five swine. Standard stainless-steel spring coils were deployed in other renal branches and served as controls. The animals underwent follow-up selective renal arteriography to determine presence or absence of vessel recanalization or device migration 15–23 days after device deployment. Histopathologic evaluation of target vessels and peripheral renal parenchyma was also performed.
Ten Embolizors and 10 stainless-steel coils were deployed in arteries ranging in size from 1.8 to 3.0 mm in diameter. The Embolizor was easily and precisely deployed. Angiographic evidence of vascular occlusion in the Embolizor group was noted within 30 seconds in eight device deployments and within 5 minutes in two. No early or delayed device migration was noted on follow-up arteriography. In the control group, seven of 10 previously occluded arteries were recanalized. No recanalization was noted in the Embolizor group. Light microscopy revealed evidence of infarction in all specimens examined. Whereas three specimens in the Embolizor group contained occasional giant cells, there were numerous multinucleated giant cells present within the interstices of all control spring coils.
The Embolizor was easily, precisely, and successfully deployed through standard selective diagnostic angiographic catheters. Short-term follow-up demonstrated no recanalization or migration of the device. The Embolizor was shown on histopathologic analysis to have no significant foreign body reaction.

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Brief reportUse of preformed nitinol snare to improve transcatheter coil delivery in occlusion of patent ductus arteriosus

Abstract

Am J Cardiol

Am J Cardiol

Brief report
Use of preformed nitinol snare to improve transcatheter coil delivery in occlusion of patent ductus arteriosus