Percutaneous Stent Implantation Into Coronary Arteries in Infants Andra ´ s Bratincsa ´ k, 1,2 * MD, PhD, Anas Salkini, 1,2 MD, Howaida G. El-Said, 1,2 MD, PhD, and John W. Moore, 1,2 MD, MPH Objectives: To investigate the feasibility, procedural techniques, safety, and overall potential of percutaneous coronary angioplasty and stent implantation in infants with coronary artery disease and acute coronary syndrome. Background: Despite exten- sive experience in adult patients, percutaneous coronary intervention remains uncommon in children and extremely rare in infants. Methods: Retrospective review including all children who underwent percutaneous coronary angioplasty in Rady Children’s Hospital—San Diego during a period of 4 years. Results: Seven children including four children less than 15 months of age underwent percutaneous coronary intervention with coronary stent implantation in the proximal portion of the left or right coronary arteries. Successful stent placement with excellent revascularization was achieved in all cases. Mean coronary artery diameter was 0.65 mm prior to stent placement. Balloon angioplasty resulted in suboptimal resolution of coronary steno- sis, thus bare metal stents were implanted in all cases, dilated to a mean of 2.5-mm internal diameter. Average intervention-free period was 434 days after stent implanta- tion. In-stent re-stenosis and stent thrombosis did not occur if the implanted stent diameter was greater than 2.5 mm and the patient received dual anti-platelet therapy. Conclusions: Our experience suggests that coronary artery stent implantation is a feasible and relatively safe palliative option in infants and toddlers with coronary stenosis. It is a viable strategy for bridging patients with acute ischemia or poor ventricular function to elective surgical revascularization or transplantation. V C 2011 Wiley Periodicals, Inc. Key words: coronary artery stenosis; congenital heart disease; pediatric intervention INTRODUCTION Percutaneous coronary intervention (PCI) with coronary stent implantation (CSI) significantly reduces mortality in adult patients with acute coronary syn- drome (ACS) and myocardial infarction [1,2]. ACS is much less common in children; however, there are several congenital and acquired cardiac diseases as well as surgical and interventional procedures in the pediatric age group that may compromise coronary cir- culation by means of internal stenosis or external com- pression [3–6]. Nevertheless, PCI is rarely performed in children with ACS and is generally not considered to be an option in infants [7] due to the increased risk of coronary interventions in this age group and the procedural difficulty of cardiac catheterization techni- ques [8]. Hereby, we review the indications, procedural tech- nique, risk factors and post-procedural care of four children less than 15 months of age with ACS who had PCI with stent implantation at Rady Children’s Hospital-San Diego (RCHSD). MATERIALS AND METHODS A retrospective review was conducted for children (less than 18 years of age), who had PCI at RCHSD from June 30, 2006 until June 30, 2010. Percutaneous coronary intervention included balloon coronary angio- plasty (BCA) and/or coronary stent implantation. We reviewed and analyzed demographic data, underlying 1 Rady Children’s Hospital, San Diego, California 2 Department of Pediatrics, University of California San Diego, School of Medicine, San Diego, California Conflict of interest: Nothing to report. *Correspondence to: Andra ´s Bratincsa ´k, MD, PhD, Rady Children’s Hospital-San Diego, 3020 Children’s Way, MC5004, San Diego, CA 92123. E-mail: bratiandris@yahoo.com Received 28 December 2010; Revision accepted 19 March 2011 DOI 10.1002/ccd.23173 Published online 30 August 2011 in Wiley Online Library (wileyonlinelibrary.com) V C 2011 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 79:303–311 (2012)