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New devices and techniques
Case series
Low profile sheaths in pediatric neurointervention: a multicenter experience
  1. Karen Chen1,
  2. Demi Dawkins2,
  3. Darren B Orbach3,
  4. Beverly Aagaard-Kienitz4
  1. 1 Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  3. 3 Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4 Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  1. Correspondence to Dr Karen Chen, Radiology, Texas Children's Hospital, Houston, TX 77030-2358, USA; kxchen1{at}texaschildrens.org

Abstract

Background Pediatric neurointervention is challenged by the appropriateness of adult catheters and devices. This multicenter report on the smallest groin access sheaths offers technical notes and clinical outcomes in the pediatric neurointerventional population.

Methods All pediatric neurointerventional cases from 2019 to 2021 were reviewed for use of a 3.3F Pediavascular or a 4F Merit Prelude Ideal low profile sheath. Hospital records were reviewed for complications and technical notes and compared with arterial groin access with the 4F Terumo Pinnacle in infants less than 1 year old, before the low profile sheaths at one author’s institution were introduced.

Results From January 1, 2019 to March 31, 2021 there were 347 procedures performed at Boston Children’s Hospital and University of Wisconsin. Forty-four procedures in 26 patients were identified in which a 3.3F (38 cases, 20 patients) or 4F (6 cases, 6 patients) sheath was used. The average age was 2.2 years (1.5 days to 18 years). Retinoblastoma intra-arterial chemotherapy infusion (18 of 44) was the most common indication. The remaining procedures comprised vein of Galen embolization (12), diagnostic cerebral angiography (13), and one preoperative tumor embolization. Morbidity included a groin hematoma and decreased pulses (4.5%). No major groin complications occurred. There was no statistically significant difference compared with the historical cohort (132 procedures), which had seven instances of decreased pulses (5.3%, p>0.05).

Conclusion The 3.3F Pediavascular and 4F Merit Prelude Ideal sheaths are easily incorporated into the pediatric neurointerventionalist’s armamentarium for infants and readily accommodate various microcatheters for distal embolization and catheterization.

  • technique
  • device
  • pediatrics
  • intervention
  • complication

https://doi.org/10.1136/neurintsurg-2021-017936

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    Footnotes

    • Contributors BA-K and DBO devised the study. KC and DD were involved in data gathering. KC analyzed the data and wrote the manuscript. All authors provided editorial support.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The views expressed in the submitted article are the authors’ own and not an official position of their respective institutions.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.