Transcatheter occlusion of the patent ductus arteriosus: use of the retrievable coil device

Differential pulmonary perfusion scan after percutaneous occlusion of the patent ductus arteriosus: one-decade consecutive longitudinal study from a single institution

Reduced left lung perfusion has been described following percutaneous occlusion of the patent ductus arteriosus (PDA). We aimed to identify the incidence of lung perfusion abnormalities and the associated risk factors in our consecutive series. Between November 1994 and December 2003, 150 procedures were performed on 145 patients, age 4.6 +/- 4 years. Gianturco coil was used in 88.2%, Amplatzer duct occluder in 6.7%, and Rashkind Umbrella in 5.5%. Lung perfusion scan was scheduled within 48 h (LPS-1), at 6-12 months (LPS-2) and later (LPS-3) in the case of persistent abnormalities. Left lung perfusion <40% was considered abnormal. LPS-1 was obtained in 95.8% and was abnormal in 31%. LPS-2, available in 48.2%, returned to normal in 65.7% (p < 0.001). LPS-3, required in 6.2%, was normal in 55.6% (p = 0.07). Identifiable risk factors were low age and height (p < 0.01), higher Q(p)/Q(s) ratio (p < 0.05), and larger PDA size indexed for height (p < 0.001) or body surface area (p < 0.01). The number of coils or loops deployed in the pulmonary end of the PDA did not influence lung perfusion. In conclusion, we describe a high incidence of left lung perfusion reduction following percutaneous PDA occlusion, more likely in the young with large PDA. However, spontaneous recovery usually occurs within a few months.

Experimental evaluation of a modified Amplatzer duct occluder

The purpose of this study was to evaluate a new device specifically designed for patent ductus arteriosus (PDA) occlusion based on PDA anatomy. Percutaneous closure of aortopulmonary shunts was attempted in 10 dogs. Shunts were surgically created in the location and orientation of PDA. The occlusion prosthesis consisted of a cylindrical frame filled with polyester and a 32 degree angled retention disk. The delivery system of the device included a 6 Fr thin-walled Teflon introducing sheath, an antirotating delivery catheter, and cable. Complete occlusion of the shunt was obtained in nine animals. One animal died before device placement. Temporary hemolysis occurred in one dog after device placement. The disk of device was completely covered by smooth glistening neoendothelium at 1-3 months postmortem examination. None of the devices protruded into the lumen of the aorta. The device is an improvement over the standard Amplatzer duct occluder. The angled retention disk lies flatly against the aortic wall, avoiding turbulence or an aortic pressure gradient.

New embolization coil containing a nitinol wire core: preliminary in vitro and in vivo experiences

PURPOSE

To improve the stability of the standard stainless steel embolization coil by adding a nitinol wire core.

MATERIALS AND METHODS

With use of one coil with a nitinol wire core and one without one, stability and resistance to elongation were measured in vitro. Thirty-one factory-made stainless-steel macrocoils equipped with preshaped nitinol wire cores were acutely deployed into branches of the superior mesenteric artery (SMA) in five pigs (part I of the study). Fifteen homemade retrievable coils with thermal shape memory (TSM) nitinol wire cores were acutely deployed in the abdominal aortae or inferior venae cavae of four pigs (part II). Coils with a superelastic (SE) nitinol wire core (n = 9), a TSM nitinel wire core (n = 5), and without a core (n = 5) were compared in carotid embolization (part III).

RESULTS

In vitro, the expansile strength of the reinforced coils was significantly greater and elongation was significantly less than the standard coils (P <.01). In part I, coils were easily deployed via diagnostic catheters. In part II, ability to reposition the coils facilitated optimal coil configuration, which resulted in effective self-anchoring and occlusion. In part III, no coils with a SE core migrated, whereas one of five with a TSM core and three of five without reinforcement migrated immediately. The core significantly increased coil stability and postplacement configuration (P <.01).

CONCLUSIONS

Addition of a nitinol wire core increases the intravascular stability of the standard embolization coil by significantly enhancing expansile force and postplacement configuration. The wire core does not adversely affect the handling of the coil. The ability to reposition/retrieve the coil is a desirable feature.

Interventional occlusion of congenital vascular malformations with the detachable Cook coil system

INTRODUCTION

Nonsurgical closure of pathologic vascular communications can be achieved by coil embolization. Different systems used in patients with congenital heart disease (e.g., patent ductus arteriosus) allow controlled release of the devices. However, they are too stiff for coil occlusion of small or tortuous vessels.

METHODS AND PATIENTS

The new detachable Cook coil system combines flexibility with a simple release control mechanism. Five children, age 8 days to 10 years, underwent heart catheterization for interventional occlusion of different vascular malformations (two coronary artery fistulas, two aortopulmonary collaterals, and one hemangioma). The diameter of the vessels varied between 1.8 mm and 3.6 mm and the length between 10 mm and 22 mm.

RESULTS

Up to four 0.018" soft spiral coils were placed as distally as possible in the feeding vessels. In addition, in two patients, one to three J-shaped coils were placed inside and proximal to spiral coils. Positioning of the coils was controlled easily by radio-opaque markers. Counter-clockwise rotation of the delivery wire provided fast and safe detachment without movement of the detached coils. Control angiograms showed complete occlusion of the vessels within 10 minutes after delivery of coils.

CONCLUSION

Interventional closure of vascular malformations can be successfully obtained with the detachable Cook coil system. This system offers safe and controlled placement of coils, and it works rapidly in an uncomplicated manner.

Comparison between the safety profile and clinical results of the Cook detachable and Gianturco coils for transcatheter closure of patent ductus arteriosus in 272 patients

OBJECTIVES

We evaluated the occlusion rate and safety of Cook detachable coils versus Gianturco coils in transcatheter closure of patent ductus arteriosus (PDA).

BACKGROUND

The Cook detachable coil recently was introduced in an attempt to improve the safety of transcatheter closure of PDA.

METHODS

Between January 1994 and September 1998, 272 patients underwent transcatheter PDA closure. Cook detachable coils were used in 137 patients, with a mean age of 43.9 months and weight of 13.8 kg. In 135 patients, Gianturco coils were used, with a mean age of 56.8 months and weight of 17.8 kg. The mean narrowest diameter of the PDA in the Cook detachable coil group was 2.85 mm versus 2.32 mm for the Gianturco coil group.

RESULTS

The Cook detachable coil group was younger and weighed less than the Gianturco group (P < 0.05 and 0.02, respectively). Their narrowest PDA diameter was larger (P < 0.01). Embolization rate was significantly lower in the Cook coil group (9[6.5%] of 137 vs 22 (16.3%) of 135; P = < 0.013). The mean follow-up for the Cook coil group was significantly shorter (0.55 years) than for the Gianturco coil group (1.18 years; P < 0.001). On an intention-to-treat basis, complete occlusion by echocardiography was achieved in 99 (72.3%) of 137 patients in the Cook detachable coil group, which was significantly less than the Gianturco coil group (114 [84.4%] of 135; P = 0.008).

CONCLUSION

Cook detachable coils for transcatheter closures of the PDA are safer than Gianturco coils. Hence, children with large ductal can be treated earlier in life. Short-term complete occlusion rate was lower in the Cook detachable coil group. This rate can be explained by a shorter follow-up time, larger ductal diameter, and the different materials used for the detachable coils.

The duct-occlud device: design, clinical results, and future directions

The successful employment of embolization coils for transcatheter occlusion of the patent ductus arteriosus (PDA) has resulted in acceptance of transcatheter occlusion as the treatment of choice for small to medium-sized PDAs. The Duct-Occlud device was developed to further improve the technique by utilizing a controlled release mechanism and coil shape specifically designed for the geometry of the ductus arteriosus. Clinical studies have demonstrated excellent efficacy with low embolization rates and low incidences of complications. Newer modifications have been designed for occlusion of larger PDAs and subaortic ventricular septal defects, and preliminary clinical results have been promising.

Interventional catheterization

Several investigations have been performed to evaluate the mid-term results of coil embolization for patent ductus arteriosus. Excellent results were obtained with coils if the minimum diameter of the ductus was less than 4 mm. Balloon dilation of native coarctation and recoarctation may be associated with complications such as aneurysm formation. Stent placement may solve some of the problems of balloon dilation, but the stents currently available are not perfect. Results of transcatheter closure of atrial septal defect using new devices have been were reported. The self-expanding nitinol double-disk device (Amplatzer septal occluder) (AGA Medical Corporation, Golden Valley, Minnesota) is becoming popular because it is easy to implant, is easy to retrieve before its release, can occlude a relatively large defect, and has a low rate of residual leak. Although the immediate results with this device were excellent, surgical closure is still the standard treatment and we need to see the long-term results of transcatheter closure.