title: Results of coil closure of patent ductus arteriosus using a tapered tip catheter for enhanced control.
abstract: OBJECTIVE
  This article describes the efficacy and embolization rates of coil delivery via modified vertebral catheter (MVC) for patent ductus arteriosus (PDA) closure.
  
  
  BACKGROUND
  Various techniques have been devised to enhance coil control and prevent embolization during PDA closure. Since 1995, they have delivered coils via tapered vertebral catheters for improved coil control.
  
  
  METHODS
  Catheterization reports, angiograms, and echocardiograms were reviewed for patients with PDA occlusion via MVC from 2001 to 2014. Residual shunting was determined by angiography and echocardiogram within 24 hr post-procedure. Procedural success was defined as ≤ trivial angiographic and echocardiographic shunt, and no aortic nor LPA obstruction, after final coil delivery.
  
  
  RESULTS
  About 125 coil occlusions were attempted in 103 patients. Minimal PDA diameter was 2 (0.6-6) mm. Four coils were removed with a snare/bioptome due to aortic/LPA obstruction following release. Seven were malpositioned while still held by the MVC of which three embolized while attempting withdrawal. Five embolized after full release from the MVC. The embolization rate was 6.4%. Embolizations were more likely in PDAs ≥ 2.5 mm (P < 0.05). Ultimately, 98/103 PDAs were occluded using the MVC. No patient had greater trivial residual shunt or aortic/LPA obstruction for an overall success rate of 95%. For PDAs < 2.5 mm the success rate was 97%.
  
  
  CONCLUSIONS
  Coil delivery via MVC was safe and effective for small PDAs. While fully controlled release and retrieval devices are now available for PDA closure with lower embolization rates, coil occlusion by MVC should still be considered for small PDAs, especially in resource limited regions. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Pediatric Cardiology, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Devanagondi
authors.affiliation: Heart Center, Joe DiMaggio Children's Hospital, Hollywood, Florida.
authors.forename: Larry
authors.initials: L
authors.lastname: Latson
authors.affiliation: Center for Pediatric and Congenital Heart Disease, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Sharon
authors.initials: S
authors.lastname: Bradley-Skelton
authors.affiliation: Center for Pediatric and Congenital Heart Disease, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Prieto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D062906:Cardiac Catheters; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D004562:Electrocardiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: PDA; coil occlusion; embolization