Percutaneous stent implantation into coronary arteries in infants

Abstract

To investigate the feasibility, procedural techniques, safety, and overall potential of percutaneous coronary angioplasty and stent implantation in infants with coronary artery disease and acute coronary syndrome. Despite extensive experience in adult patients, percutaneous coronary intervention remains uncommon in children and extremely rare in infants. Retrospective review including all children who underwent percutaneous coronary angioplasty in Rady Children's Hospital-San Diego during a period of 4 years. Seven children including four children less than 15 months of age underwent percutaneous coronary intervention with coronary stent implantation in the proximal portion of the left or right coronary arteries. Successful stent placement with excellent revascularization was achieved in all cases. Mean coronary artery diameter was 0.65 mm prior to stent placement. Balloon angioplasty resulted in suboptimal resolution of coronary stenosis, thus bare metal stents were implanted in all cases, dilated to a mean of 2.5-mm internal diameter. Average intervention-free period was 434 days after stent implantation. In-stent re-stenosis and stent thrombosis did not occur if the implanted stent diameter was greater than 2.5 mm and the patient received dual anti-platelet therapy. Our experience suggests that coronary artery stent implantation is a feasible and relatively safe palliative option in infants and toddlers with coronary stenosis. It is a viable strategy for bridging patients with acute ischemia or poor ventricular function to elective surgical revascularization or transplantation.