Percutaneous coronary intervention is not a generally accepted option for infants or toddlers with acute coronary syndrome. However, a new report published in the August issue of Catheterization and Cardiovascular Interventions, a journal of The Society for Cardiovascular Angiography and Interventions (SCAI), found coronary stent implantation to be a feasible and safe palliative option for children fifteen months and younger.
Studies have shown that in adults with acute coronary syndrome stent implantation significantly reduces mortality. While acute coronary syndrome is less common in children there are congenital and acquired heart disease that may compromise coronary circulation in the paediatric population. Due to increased risk of coronary interventions and difficulty of cardiac catheterisation techniques in paediatric patients, percutaneous coronary intervention is not a recommended treatment strategy in this age group.
A research team led by András Bratincsák from Rady Children’s Hospital in San Diego, USA, conducted a retrospective review of seven children who had percutaneous coronary intervention between June 2006 and June 2010. Of those included in the study all were under 18 years of age and four were 15 months or younger. Percutaneous coronary intervention techniques included balloon coronary angioplasty and coronary stent implantation. Researchers analysed patient data that included underlying diagnosis, co-morbidites, catheterisation technique, and outcomes.
In all seven cases, successful stent placement in the proximal portion of the left or right coronary arteries with excellent revascularisation was achieved. The average diameter of the heart arteries was 0.65mm prior to the intervention. Balloon angioplasty did not completely resolve the stenosis and bare metal stents were then implanted to a mean internal diameter of 2.5mm. The team determined that the average intervention-free period was 434 days after stent implantation. Restenosis and thrombosis did not occur in cases where the implanted stent diameter was greater than 2.5mm and patients received dual anti-platelet therapy.
“We provide evidence that stent implantation is a relatively safe option for paediatric patients with coronary stenosis, including those under the age of 15 months,” said Bratincsák. “Percutaneous coronary intervention offers a viable strategy for bridging infants and toddlers with blocked arteries or poor ventricular function to surgical revascularisation or transplantation when they are at an older age.”
“Percutaneous Stent Implantation into Coronary Arteries in Infants.” Andras Bratincsa, Anas Salkini, Howaida G El-Said and John W Moore. Catheterization and Cardiovascular Interventions; Published Online: 22 August 2011 (DOI: 10.1002/ccd.23173); Print Issue Date: August 2011. http://doi.wiley.com/10.1002/ccd.23173