The snare-assisted technique for transcatheter coil occlusion of moderate to large patent ductus arteriosus: Immediate and intermediate results

OBJECTIVES The purpose of this study was to evaluate the feasibility, safet y and efficacy of using a snare-assisted technique to coil occlude the mode rate to large size patent ductus arteriosus (PDA). BACKGROUND Transcatheter occlusion of small PDAs using Gianturco coils is s afe and effective. However, in larger size PDAs and/or those with short PDA length, the procedure still carries risks of coil embolization, incomplete occlusion and failure to implant the coil. METHODS From January 1994 to June 1997 the records of 104 consecutive snare -assisted coil occlusions of moderate to large PDAs (minimum diameter >2.0 mm) were reviewed. Immediate and intermediate outcomes including complete a nd partial occlusion, failure to implant and complications were analyzed wi th respect to ductal type and size. RESULTS Patient age ranged from 0.1 to 70.1 years (median 3.3 years). Minim um PDA diameter ranged from 2.1 to 6.8 mm (mean 3.0 +/- 0.9 mm). Angiograph ic types were A-62, B-13, C-6, D-14 and E-9. Using the snare-assisted techn ique, coil placement was successful in 104/104 patients (100%), irrespectiv e of size or angiographic type. Immediate complete closure was observed in 73/104 (70.2%) and was related to smaller PDA size, but not to angiographic type. Immediate complete closure was type Complete closure was documented in 102/104 (98.1%) at 2- to 16-month follow-up. Successful closure was unre lated to PDA size or type. Coil embolization to the pulmonary artery occurr ed in 3/104 (2.9%) patients and was not related to PDA size or type. The ne ed far multiple coils was found in 28/104 patients (26.9%), and was related to larger PDA size, but not to angiographic type. CONCLUSIONS The snare-assisted delivery technique allows successful occlusi on of moderate to large PDAs up to 6.8 mm, irrespective of angiographic typ e. This technique permits improved control and accuracy of coil placement, and facilitates delivery of multiple multiple coils. (C) 1999 by the Americ an College of Cardiology.