Thrombectomy by rheolytic and aspiration systems can be safe and efficient for children, when keeping in mind their need for smaller catheter sizes and shorter application times, according to a small, single-center study.
Thrombectomy was successful in 86% of children (and 94% of vessels), most of whom received additional stent therapy or tPA administration.
After a median follow-up of 10 months, all revascularized vessels remained patent, although 44% of patients went back to the cath lab for angioplasty or repeat thrombectomy, Athar M. Qureshi, MD, of Texas Children’s Hospital in Houston, and colleagues reported online in Catheterization and Cardiovascular Interventions.
The researchers pointed out a 9.5% rate of asystole when the AngioJet rheolytic thrombectomy system was used with long burst times (longer than 5 seconds). Those patients were resuscitated with brief CPR.
“These interventions can be performed safely even in critically ill children with life-threatening thrombosis,” especially when safety precautions — such as limiting the burst time of the AngioJet, and providing a transfusion of red blood cells — are heeded, they concluded.
They wrote that “aspiration and rheolytic thrombectomy systems designed for adults have important applications in children,” and at least some are available in sizes suitable for both the pediatric peripheral and central vasculature.
There were 21 patients in the retrospective study, which included infants and children up to 18 years of age.
Qureshi reported no relevant conflicts of interest.
Catheterization and Cardiovascular Interventions
Qureshi AM, et al “Efficacy and safety of catheter-based rheolytic and aspiration thrombectomy in children” Catheter Cardiovasc Interv 2016; DOI: 10.1002/ccd.26399.