Double-helix coil for occlusion of large patent ductus arteriosus: evaluation in a chronic lamb model.
نویسندگان
چکیده
OBJECTIVES We sought to evaluate the efficacy and tissue reaction of a new miniature interventional device for occlusion of large patent ductus arteriosus (PDA) in a neonatal lamb model. BACKGROUND A variety of devices are used to close PDAs by interventional measures. Spring coils found to have a high cumulative occlusion rate have thus far been limited to smaller PDAs because of the physical limitation of grip forces. METHODS Memory-shaped double-cone stainless steel coils with enhanced stiffness of the outer rings by a double-helix configuration were mounted on a titanium/nickel core wire. A snap-in mechanism attaches the coil to the delivery wire, allowing intravascular coil retrieval and repositioning. The system was placed through a 4F or 5F Teflon catheter. A chronic lamb model (n = 8) of PDA (>5 mm) was used in which ductus patency was secured by a protocol of repetitive angioplasty procedures. The animals were killed after 1 to 181 days, and the ductal region was examined by inspection as well as by light and electron microscopy. RESULTS Placement of the coils within the PDA was possible in all lambs. Before final detachment, the coils were retrieved or repositioned, or both, up to 12 times. In all but one animal the ductus was closed within 6 days after the procedure. The coils caused no infections or aortic and pulmonary artery obstruction. Histologic and electron microscopic studies revealed endothelial coverage of the implants but no foreign body reaction or local or systemic inflammation or erosion of the implant. CONCLUSIONS The device effectively closed large PDAs in our model and may overcome the previous limitations of coils. Clinical trials are indicated.
منابع مشابه
Patent ductus arteriosus in a lamb: A case report
Patent ductus arteriosus (PDA) is a persistent patency of a vessel normally present in the fetus that connects the pulmonary arterial system to the aorta. The ductus arteriosus fails to close at birth when breathing commences and placental blood circulation is removed. Closure of the ductus arteriosus arises in response to decline pulmonary vascular resistance and increased systemic vascular re...
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[1] Shim D, Fedderly RT, Beekman III RH, Ludomirsky A, Young ML, Schork MA, Lloyd TR. Follow-up of coil occlusion of patent ductus arteriosus. J Am Coll Cardiol 1996; 28. 207-11. [2] Galal O, de Moor M, Fadley F et al. Problems encountered during introduction of Gianturco coils for transcatheter occlusion of the patent arterial duct. Eur Heart J 1997; 18: 625-30. [3] Sommer RJ, Gutierrez A, Lai...
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عنوان ژورنال:
- Journal of the American College of Cardiology
دوره 31 3 شماره
صفحات -
تاریخ انتشار 1998