Multicenter pivotal trial of the Minima stent for vascular stenosis in infants and young children
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Background
The Minima Stent System is the first stent designed, tested, and FDA-approved for use in neonates, infants, and children. Our objective was to evaluate the safety and efficacy of Minima implantation for pulmonary artery stenosis (PAS) and coarctation of the aorta (CoA).
Methods
Multicenter, single-arm, prospective, non-randomized trial. Primary endpoints included stenosis relief, freedom from device-related serious adverse events (SAEs) or surgical intervention through 6-months, and maintenance of vessel lumen diameter on computed tomography or catheter angiography at 6-months.
Results
Forty-two patients (21 PAS, 15 recurrent CoA, 6 native CoA) underwent Minima implantation at a median age and weight of 9 (range 0.4-112) months and 7.8 (3.4-28.3) kg. Implantation was successful in 41 (97.6%) and resulted in a median increase in minimal vessel diameter of 131% (46-483%) and reduction in median pressure gradients from 25 (0-63) mmHg to 0 (0-6;p<0.001) mmHg in CoA patients. Two acute PAS stent embolizations occurred; both stents were secured in the contralateral PA, and one was treated with an additional Minima stent. Seven CoA patients, all under 6kg, experienced transient femoral artery thrombosis. At 6-months there were no explants or device-related SAEs. Luminal diameter was maintained at 89% (59-137%) of implant diameter. During a median follow-up of 596 (412-979) days, 13 (31%;7 CoA, 6 PAS) patients underwent planned stent expansion without complications.
Conclusions
The Minima system is safe and effective for treating PAS and CoA in infants and small pediatric patients. Luminal patency was preserved, and planned re-interventions for somatic growth seem well tolerated in early follow-up.
What Is Known?
Endovascular stent therapy for infants and small children with congenital heart disease has remained highly challenging due to a dearth of available tools specifically designed, tested, and approved for use in this unique population.
What the Study Adds.
The Minima Stent System, specifically designed for infants and small children, has demonstrated safety and effectiveness in treating both native and post-surgical coarctation of the aorta and pulmonary artery stenosis in this population. On follow-up imaging, vessel patency and caliber were well-preserved, and further elective expansion of the stent to accommodate somatic growth was well-tolerated. Additional follow-up of the current cohort and other post-approval implants is needed to better understand the long-term performance of the Minima stent as patients approach adult size.
