Pediatric Traumas and Paradigm Shifts: The Necessary Adaption of the Steerable Microcatheter in Pediatric Interventional Radiology.

Taylor S Harmon,Jerry Matteo,Joanna Kee-Sampson,Saeed Bashir,Timothy S Hester

doi:10.7759/cureus.4125

Abstract

The use of traditionally available intra-arterial devices have historically been designed with the adult patient population in mind. Currently, there are not manufactured devices specifically tailored for use during pediatric interventional procedures, pressuring interventional operators to adapt commonplace and readily available devices for interventional management. Experienced interventional operators understand that pediatric and adult interventions can entail vastly different management, affecting patient care and outcomes. To address the pitfalls in pediatric interventional management, an accredited fellowship specifically for pediatric interventional radiology is available. However, devices must equally evolve with the training available in order to adequately address interventional management of the pediatric patient population. Interventional device innovation can be considered the initial step towards bridging the technical and procedural gaps necessary for refining pediatric intervention. The introduction of steerable microcatheters in interventional radiology has innovated procedural protocols, but has never been documented in pediatric patients until this time.

Highlights

Pediatric trauma can often involve the vasculature or solid organs, requiring various imaging modalities for work-up and diagnosis
Solid organ injury can be the result of blunt force trauma in the pediatric population, in such case, a contrast-enhanced computed tomography (CT) of the abdomen and pelvis could direct interventional embolization if necessary
Though not necessarily developed for the pediatric patient population, steerable microcatheters have been documented as efficient devices that allow interventional operators to perform a broad spectrum of procedures in less time and with less radiation exposure to the patient [5]

Summary

Introduction

Pediatric trauma can often involve the vasculature or solid organs, requiring various imaging modalities for work-up and diagnosis. The angiogram shows the SwiftNINJA® steerable microcatheter (red arrow) depositing the first pushable coil (yellow arrow) during the splenic artery embolization. We show the SwiftNINJA® steerable microcatheter accessing the patient's left internal iliac artery (red arrow), without the use of a guidewire. An angiogram of the patient's left internal iliac artery was done through the SwiftNINJA® steerable microcatheter (red arrow), demonstrating the absence of contrast extravasation (yellow arrow), and negating the need for pelvic embolization. A hand injected contrast angiogram through a SwiftNINJA® steerable microcatheter (red arrow) shows vessel cut off (yellow arrow) in the left renal artery, indicating transection. A 3 mm by 3 cm Cook® Hilal pushable coil (red arrow) is seen after deployment through the SwiftNINJA® steerable microcatheter, in a successful attempt to embolize the patient's upper mid-pole segmental branch of the left renal artery. The patient tolerated the procedure well without any immediate complications

Discussion

Conclusions

Disclosures