Hitesh Agrawal, Athar M. Qureshi, Henri Justino
Texas Children’s Hospital and Baylor College of Medicine.
United States
Catheterization and Cardiovascular Interventions
Catheter Cardiovasc Interv 2018; 91: 1110-1118
DOI: 10.1002/ccd.27469
Abstract
Background: Use of small diameter stents in young children and jailing of side branches pose significant challenges to future re-interventions. We sought to assess the capacity to induce longitudinal fractures in undersized stents to increase vessel diameter, and side cell fractures to enlarge stenotic jailed branches.
Methods: Retrospective review of patients who underwent attempted intentional stent fractures (ISF) from 01/06-02/17.
Results: Twenty-two patients, median age 4.4 (1.1-47.8) years, weighing 14.3 (6.9-102) kg underwent attempted ISF in 32 vessels. Initial stent implant occurred at a median age of 1.0 (0.1-34.1) years, at the following sites: pulmonary arteries (11), pulmonary veins (14), systemic veins (6), and aorta (1). Initial diameters of the stents were 3.5-12 mm. Thirteen vessels had overlapping stents. Using high-pressure balloons, longitudinal ISF was achieved in 23 and side cell ISF in eight vessels. One longitudinal ISF attempt was unsuccessful. Three lesions were immediately re-stented after longitudinal ISF, and three lesions treated with angioplasty (1) or stenting (2) after side cell ISF. Only one complication occurred (pseudoaneurysm in a pulmonary artery after longitudinal ISF requiring placement of a covered stent). At a median follow up of 2.0 years (2 days – 10.8 years), eight patients had 16 additional interventions for restenosis at site of ISF.
Conclusions: ISF can be induced safely in a variety of vascular beds using high-pressure balloons both longitudinally or through side cells. Longitudinal ISF only rarely requires immediate placement of a new stent; however, late restenosis may occur, requiring re-stenting.
Category
Segmental Pulmonary Venous Disease. Without a Focus on Pulmonary Hypertension
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease and Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
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