Percutaneous coronary intervention in pediatric and adolescent patients.
OBJECTIVE
Percutaneous coronary intervention (PCI) is commonly used in adult patients with coronary artery disease, but data on PCI in children and adolescents remain limited. Herein, we describe our experience with the use of PCI in pediatric and adolescent patients.


METHODS
This is a retrospective review.


METHODS
The study was conducted at Mayo Clinic, Rochester, MN.


METHODS
All patients ≤18 years old who underwent PCI from 2004 to 2012 were included.


METHODS
Intravascular ultrasound and balloon angioplasty were performed in all patients, with subsequent stent placement in 6/7 (86%) procedures.


METHODS
Residual postintervention stenosis, early procedural morbidity and mortality were the outcome measures.


RESULTS
Overall, seven unique PCI procedures were performed in five patients (four males, mean age 13.2 ± 3.8 years, range 8-18 years). Mean follow-up interval was 2 (0.6-5.5) years. Indications for the procedures included transplant coronary vasculopathy (n = 1), coronary dissection (n = 1), and acute coronary thrombosis/myocardial infarction (n = 1). Additionally, there were two patients (n = 2) who experienced coronary compression as a sequelae of prior heart surgery. Intravascular ultrasound and balloon angioplasty were performed in all patients, with subsequent stent placement in 6/7 (86%) procedures. A total of eight stents were placed (average stent diameter 3 ± 0.5 mm), including six (75%) drug-eluting stents. The targeted coronary artery lesions were successfully treated in all seven procedures. There was no early procedural morbidity or mortality. Two patients were noted to have angiographic evidence of in-stent restenosis at 3 and 15 months postdeployment, respectively, despite treatment with aspirin and clopidogrel.


CONCLUSIONS
PCI in children and adolescents can be utilized to improve coronary blood flow in a variety of clinical situations. It may be particularly effective in cases of postsurgical coronary compression. Close angiographic follow-up is critical as these patients are at risk for in-stent restenosis.
Department of Pediatrics, Mayo Clinic, Rochester, Minn, USA.
Andrew E
AE
Schneider
Jonathan N
JN
Johnson
Nathaniel W
NW
Taggart
Allison K
AK
Cabalka
Donald J
DJ
Hagler
Guy S
GS
Reeder
Frank
F
Cetta
D000293:Adolescent; D000367:Age Factors; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D002648:Child; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008910:Minnesota; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
Coronary Artery Vasculopathy; Coronary Stenting; Drug-Eluting Stent; Pediatric; Percutaneous Coronary Intervention