Transcatheter occlusion of the patent ductus arteriosus with a single device technique: comparison between the Cook detachable coil and the Rashkind umbrella device

Transcatheter coil occlusion of the patent ductus arteriosus (PDA) has beco me the interventional treatment option of choice. Immediate occlusion of an y residual shunting results in excellent closure rates, but frequently requ ires multiple coil deployment. Aims: To assess the efficacy and limitations of single Cook detachable coil PDA closure compared to a preceding series of Rashkind umbrella procedures. Methods and results: Between 1990 and 1999 . transcatheter occlusion of a small (<2 mm: n=45) or moderate-sized (2-4 m m: n=47) PDA was successfully attempted in 90/92 consecutive patients (mean ape 6 +/-4.8 years) with a coil (39/41) or Rashkind device (51/51). Immedi ate angiographic closure rates for both devices were low. although better f or small (54-68%) than moderate ducts (7-22%. P <0.01). A 2-year echocardio graphic closure rate of small ducts increased to 92% fur the coil group ver sus 95% for the Rashkind group. By that rims, moderate-sized ducts were onl y occluded in 64% with the coil and 54% with the Rashkind device. A visible residual shunt at post-implant angiography in moderate ducts was associate d with a high incidence (59%) of long-term echocardiographic shunt patency and a need for repeat intervention for audible residual shunts (32%). Concl usions: Single coil transcatheter occlusion is the treatment of choice for the small duct as most residual shunts will resolve spontaneously. However, long-term shunt persistence after single coil deployment in moderate sized ducts is as frequent as with the Rashkind device. A primary multiple coil approach is advocated if the postcoil aortogram shows residual ductal shunt ing and if there is persistence of a ductal murmur on auscultation. (C) 200 1 Elsevier Science Ireland Ltd. All rights reserved.