Study Finds Coronary Artery Stenting Is a Viable Palliative Option for Infants and Toddlers

August 22, 2011—In Catheterization and Cardiovascular Intervention, András Bratincsák, MD, et al published a study online ahead of print that found coronary stent implantation to be a feasible and safe palliative option for children 15 months and younger.

Although studies have shown that stent implantation significantly reduces mortality in adults with acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) is not a generally accepted option for infants or toddlers with acute coronary syndrome. ACS is less common in children but there are congenital and acquired heart diseases that may compromise coronary circulation in the pediatric population. Because of the increased risk of coronary interventions and difficulty of cardiac catheterization techniques in pediatric patients, PCI is not a recommended treatment strategy in this age group.

The investigators conducted a retrospective review of seven children who had PCI between June 2006 and June 2010. All patients included in the study were under 18 years of age and four were 15 months or younger. PCI techniques included balloon coronary angioplasty and coronary stent implantation. The investigators analyzed patient data that included underlying diagnosis, comorbidites, catheterization technique, and outcomes.

The investigators reported that successful stent placement in the proximal portion of the left or right coronary arteries with excellent revascularization was achieved in all seven cases. The average diameter of the heart arteries was 0.65 mm before the intervention. Balloon angioplasty did not completely resolve the stenosis and bare-metal stents were then implanted to a mean internal diameter of 2.5 mm. The investigators determined that the average intervention-free period was 434 days after stent implantation. Restenosis and thrombosis did not occur in cases where the implanted stent diameter was > 2.5 mm and patients received dual-antiplatelet therapy.

“We provide evidence that stent implantation is a relatively safe option for pediatric patients with coronary stenosis, including those under the age of 15 months,” said Dr. Bratincsák. “PCI offers a viable strategy for bridging infants and toddlers with blocked arteries or poor ventricular function to surgical revascularization or transplantation when they are at an older age.”