Closing Hard to Access Aberrant Vessels in Children Using a Novel Microcatheter and Large Volume Detachable Coils

Objectives: Closing aberrant vessels in young children and patients with structural heart disease can be challenging due to their acute angle of origin and tortuous course. Standard catheters are often too thick and rigid for deep intubation and placement for occlusion devices. Moreover, often only incomplete occlusion of large vessels is achieved.

Methods: A new 2.6-F high-flow microcatheter (Lantern delivery microcatheter; Penumbra Inc., United States) was developed to access tortuous vessels and place large volume, soft detachable coils (Ruby coils), coils with a distal anchoring system and secondary stretch-resistant nitinol wire (POD occlusion device), as well as dense packing coils (POD packing coils). We report our experience in percutaneous occlusion of hard to access major aortopulmonary collateral arteries (MAPCAs), large high-flow pulmonary sequestration arteries, and venovenous collaterals in five patients using the novel Lantern microcatheter, Ruby, and POD packing coils.

Result: Pulmonary sequestration arteries arising from the descending thoracic aorta in an acute angle and from the abdominal aorta with a subsequent tortuous course were closed in 4- and 7-year-old patients, respectively. In a 5-year-old patient with double inlet left ventricle, s/p Fontan's completion, and another 13-year-old patient with the corrected tetralogy of Fallot, three MAPCAs were closed arising from the subclavian artery. One adult patient with tricuspid atresia, s/p Fontan's completion underwent closure of a venovenous collateral arising from the innominate vein. Despite unsuccessful occlusion attempts during previous catheterizations in three of the five patients, we were able to close the aberrant vessels successfully in all of them.

Conclusion: The Lantern microcatheter and different detachable penumbra coils are very valuable in closing MAPCAs, sequestration arteries, and venovenous collaterals. This system may become an additional tool in young children and patients with structural heart disease for closing hard to access and tortuous vessels, as well as large arteries with high blood flow.

Publication History

Article published online:
21 February 2021