Percutaneous coronary intervention in pediatric and adolescent patients

Andrew E. Schneider, Jonathan N. Johnson, Nathaniel W. Taggart, Allison K. Cabalka, Donald J. Hagler, Guy S. Reeder, Frank Cetta

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: Percutaneous coronary intervention (PCI) is commonly used in adult patients with coronary artery disease, but data on PCI in children and adolescents remain limited. Herein, we describe our experience with the use of PCI in pediatric and adolescent patients. Design: This is a retrospective review. Setting: The study was conducted at Mayo Clinic, Rochester, MN. Patients: All patients ≤18 years old who underwent PCI from 2004 to 2012 were included. Interventions: Intravascular ultrasound and balloon angioplasty were performed in all patients, with subsequent stent placement in 6/7 (86%) procedures. Outcome Measures: Residual postintervention stenosis, early procedural morbidity and mortality were the outcome measures. Results: Overall, seven unique PCI procedures were performed in five patients (four males, mean age 13.2 ± 3.8 years, range 8-18 years). Mean follow-up interval was 2 (0.6-5.5) years. Indications for the procedures included transplant coronary vasculopathy (n = 1), coronary dissection (n = 1), and acute coronary thrombosis/myocardial infarction (n = 1). Additionally, there were two patients (n = 2) who experienced coronary compression as a sequelae of prior heart surgery. Intravascular ultrasound and balloon angioplasty were performed in all patients, with subsequent stent placement in 6/7 (86%) procedures. A total of eight stents were placed (average stent diameter 3 ± 0.5mm), including six (75%) drug-eluting stents. The targeted coronary artery lesions were successfully treated in all seven procedures. There was no early procedural morbidity or mortality. Two patients were noted to have angiographic evidence of in-stent restenosis at 3 and 15 months postdeployment, respectively, despite treatment with aspirin and clopidogrel. Conclusion: PCI in children and adolescents can be utilized to improve coronary blood flow in a variety of clinical situations. It may be particularly effective in cases of postsurgical coronary compression. Close angiographic follow-up is critical as these patients are at risk for in-stent restenosis.

Original languageEnglish (US)
Pages (from-to)228-234
Number of pages7
JournalCongenital Heart Disease
Volume9
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Percutaneous Coronary Intervention
Pediatrics
Stents
Balloon Angioplasty
clopidogrel
Outcome Assessment (Health Care)
Morbidity
Coronary Thrombosis
Drug-Eluting Stents
Mortality
Aspirin
Thoracic Surgery
Dissection
Coronary Artery Disease
Coronary Vessels
Pathologic Constriction
Myocardial Infarction
Transplants

Keywords

  • Coronary artery vasculopathy
  • Coronary stenting
  • Drug-eluting stent
  • Pediatric
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Medicine(all)

Cite this

Schneider, A. E., Johnson, J. N., Taggart, N. W., Cabalka, A. K., Hagler, D. J., Reeder, G. S., & Cetta, F. (2014). Percutaneous coronary intervention in pediatric and adolescent patients. Congenital Heart Disease, 9(3), 228-234. https://doi.org/10.1111/chd.12130

Percutaneous coronary intervention in pediatric and adolescent patients. / Schneider, Andrew E.; Johnson, Jonathan N.; Taggart, Nathaniel W.; Cabalka, Allison K.; Hagler, Donald J.; Reeder, Guy S.; Cetta, Frank.

In: Congenital Heart Disease, Vol. 9, No. 3, 2014, p. 228-234.

Research output: Contribution to journalArticle

Schneider, AE, Johnson, JN, Taggart, NW, Cabalka, AK, Hagler, DJ, Reeder, GS & Cetta, F 2014, 'Percutaneous coronary intervention in pediatric and adolescent patients', Congenital Heart Disease, vol. 9, no. 3, pp. 228-234. https://doi.org/10.1111/chd.12130
Schneider AE, Johnson JN, Taggart NW, Cabalka AK, Hagler DJ, Reeder GS et al. Percutaneous coronary intervention in pediatric and adolescent patients. Congenital Heart Disease. 2014;9(3):228-234. https://doi.org/10.1111/chd.12130
Schneider, Andrew E. ; Johnson, Jonathan N. ; Taggart, Nathaniel W. ; Cabalka, Allison K. ; Hagler, Donald J. ; Reeder, Guy S. ; Cetta, Frank. / Percutaneous coronary intervention in pediatric and adolescent patients. In: Congenital Heart Disease. 2014 ; Vol. 9, No. 3. pp. 228-234.
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AB - Objective: Percutaneous coronary intervention (PCI) is commonly used in adult patients with coronary artery disease, but data on PCI in children and adolescents remain limited. Herein, we describe our experience with the use of PCI in pediatric and adolescent patients. Design: This is a retrospective review. Setting: The study was conducted at Mayo Clinic, Rochester, MN. Patients: All patients ≤18 years old who underwent PCI from 2004 to 2012 were included. Interventions: Intravascular ultrasound and balloon angioplasty were performed in all patients, with subsequent stent placement in 6/7 (86%) procedures. Outcome Measures: Residual postintervention stenosis, early procedural morbidity and mortality were the outcome measures. Results: Overall, seven unique PCI procedures were performed in five patients (four males, mean age 13.2 ± 3.8 years, range 8-18 years). Mean follow-up interval was 2 (0.6-5.5) years. Indications for the procedures included transplant coronary vasculopathy (n = 1), coronary dissection (n = 1), and acute coronary thrombosis/myocardial infarction (n = 1). Additionally, there were two patients (n = 2) who experienced coronary compression as a sequelae of prior heart surgery. Intravascular ultrasound and balloon angioplasty were performed in all patients, with subsequent stent placement in 6/7 (86%) procedures. A total of eight stents were placed (average stent diameter 3 ± 0.5mm), including six (75%) drug-eluting stents. The targeted coronary artery lesions were successfully treated in all seven procedures. There was no early procedural morbidity or mortality. Two patients were noted to have angiographic evidence of in-stent restenosis at 3 and 15 months postdeployment, respectively, despite treatment with aspirin and clopidogrel. Conclusion: PCI in children and adolescents can be utilized to improve coronary blood flow in a variety of clinical situations. It may be particularly effective in cases of postsurgical coronary compression. Close angiographic follow-up is critical as these patients are at risk for in-stent restenosis.

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KW - Percutaneous coronary intervention

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