Percutaneous carotid artery access in infants < 3 months of age.

BACKGROUND: Carotid artery access in infants with congenital heart disease undergoing cardiac catheterization via a surgical cut down has been well described. There is a paucity of information regarding percutaneous carotid artery (CA) access in infants <3 months.

METHODS: A retrospective review of infants <3 months of age undergoing cardiac catheterization via percutaneous CA approach was performed after IRB approval. Between January 2012 and May 2015, 18 patients underwent 20 procedures; median age 13 days (2-77); median weight 3.3 kg (1.6-5). Procedures performed were patent ductus arteriosus (PDA) stenting (8), modified blalock taussig (BT) shunt stenting (3), balloon aortic valvuloplasty (6), and balloon angioplasty of coarctation (3).

RESULTS: Percutaneous access was obtained with a Doppler needle under ultrasound guidance into the right (16) and left CA (4). Sheath size used was 4 Fr (17), 5 Fr (2), and 6 Fr (1). Median time to sheath insertion was 6.5 min (2-20). Percutaneous access was obtained successfully in all cases. There were no major procedural complications. There were two minor complications; hypotension, and ductal spasm. Hemostasis was achieved by manual compression; median time was 14.5 min (8-36). There were two post-procedural complications involving development of CA pseudo aneurysms that were repaired surgically. Post-procedure CA patency was documented by angiography (3), MRA (3), or vascular ultrasound (14). There were no documented arterial occlusions.

CONCLUSION: Our experience suggests that percutaneous CA access in infants <3 months of age is safe and feasible with preserved vascular patency and no neurological adverse events.