The Wire Twisting/Locking Technique to Facilitate Precise PDA Stent Delivery in Neonates with Ductal-Dependent Pulmonary Blood Flow

Patent ductus arteriosus (PDA) stenting is an established alternative to systemic-to-pulmonary artery shunts for neonates with ductal-dependent pulmonary blood flow, offering a less invasive approach. However, the procedure remains technically challenging and prone to complications. We evaluated the wire twisting/locking technique to improve precision and safety during PDA stenting. This retrospective study, approved by the UC San Diego Institutional Review Board, analyzed the application of the wire twisting/locking technique for PDA stenting between Jan 2021 and Dec 2024. Data were extracted from electronic medical records, including patient demographics, diagnoses, procedural details, and outcomes. The wire twisting/locking technique was applied in 18 PDA stenting procedures performed on 11 patients with complex cyanotic congenital heart disease. The procedures included initial PDA stenting (n = 10) and PDA stent re-interventions (n = 8), comprising four balloon dilations and four stent placements. The median age of initial stent replacement was 9 days (IQR: 8-90), and the median weight was 3.88 kg (IQR: 3.17-6.05). Access sites included carotid (n = 10), femoral (n = 4), axillary (n = 2), and umbilical arteries (n = 2). The median stent diameter was 2.05 mm (IQR: 1.5-2.4), and the median stent length was 24.35 mm (IQR: 22-30 mm). The median procedure time was 91 min (IQR: 62-130) and a median radiation dose of 154.73 Gycm². All procedures were successful, with no vascular or pulmonary complications. Median discharge oxygen saturation was 85% (IQR: 82-89). The wire twisting/locking technique represents a promising modification for PDA stenting. Utilizing a dynamic soft wire and opting for a single long stent simplifies stent placement and minimizes procedural complications.