title: Percutaneous Common Carotid Artery Access for Pediatric Interventional Cardiac Catheterization.
abstract: BACKGROUND
  Surgical cutdown for access to the common carotid artery provides a more direct route for certain pediatric cardiac interventions and avoids femoral artery injury in small infants. The safety of percutaneous carotid access (PCA) in children is unknown.
  
  
  RESULTS
  Retrospective review of PCA at Texas Children's Hospital and Children's Healthcare of Atlanta. From July 2006 to November 2014, 42 patients underwent 47 attempts at catheterization via PCA. Median (range) age was 20 days (0 days-2.9 years) and weight was 3.2 kg (1.1-12.2). Two patients had failed PCA with no sequelae. Of the 45 catheterizations with successful PCA and sheath placement, 44 interventions were performed, the most common being stenting or stent redilation of the ductus arteriosus, balloon aortic valvuloplasty, and stenting or angioplasty of Blalock-Taussig shunts. After sheath withdrawal, hemostasis was achieved with manual compression, with no need for surgical control of bleeding. Follow-up carotid imaging was performed in all. Acutely, 3 patients developed carotid thrombosis with resolution in 1 and mild residual narrowing in 2 after anticoagulation therapy. At follow-up, 40 of 42 patients (95%) had a normal carotid artery, with 2 instances of mild stenosis. There were no neurological sequelae attributable to PCA.
  
  
  CONCLUSIONS
  PCA is safe even in small infants, and hemostasis can be achieved without surgical repair, with a carotid patency rate superior to published data after surgical cutdown. Surgical cutdown is not routinely required for pediatric cardiac catheterization via the carotid artery.
authors.affiliation: From the C.E. Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital (H.J.); Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX (H.J.); and Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, GA (C.J.P.). hjustino@bcm.edu.
authors.forename: Henri
authors.initials: H
authors.lastname: Justino
authors.affiliation: From the C.E. Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital (H.J.); Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX (H.J.); and Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, GA (C.J.P.).
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
mesh_terms: D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D062906:Cardiac Catheters; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002675:Child, Preschool; D004867:Equipment Design; D005845:Georgia; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006489:Hemostatic Techniques; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011312:Pressure; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D016896:Treatment Outcome
keywords: Blalock–Taussig shunt; angioplasty; aortic valve stenosis; carotid artery; ductus arteriosus