Technical Success and Adverse Events Associated With Percutaneous Carotid Artery Access for Transcatheter Procedures in Infants.

BACKGROUND

Demand for transcatheter interventions in small neonates continues to increase. Percutaneous carotid artery access can facilitate intervention by providing a more direct wire course and/or potentially reduce morbidity associated with femoral artery access in very small patients. To our knowledge, there remains limited information on the technical success and adverse events associated with carotid access in this population.

METHODS

A single-center retrospective case series was performed of infants undergoing carotid access between January 6, 2020, and September 30, 2025, for catheterization procedures, describing the patients, procedures, and outcomes of these procedures, including protocolized ultrasound evaluation of carotid access sites and incidence of vascular and neurological complications.

RESULTS

During the study period, 105 procedures using PCA were performed in 77 individual patients at median age of 10 days (IQR: 5-63) and median weight 3.2 kg (IQR: 2.8-3.9) for stent angioplasty of the ductus arteriosus in 84%, intervention on surgical shunts in 9%, and balloon aortic valvuloplasty in 5%. One hundred percent of procedures were technically successful. There were no neurological complications. Vascular ultrasound was performed in all subjects. Pseudoaneurysms occurred after two cases, and in one case, surgical repair was performed. Follow-up imaging was available in 74% of subjects with no pathology identified after a median follow-up of 218 days (IQR: 94-761). Similarly, no clinical events attributable to carotid access were seen during clinical follow-up (median: 785 days, IQR: 330-1336).

CONCLUSION

PCA can be used to facilitate a range of transcatheter interventions, including repeated access in the same vessel. Adverse events were very rare, and no neurological complications were seen in short term follow-up.