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New mechanical recanalization devices - the future in pediatric stroke treatment?
Iris Quasar Grunwald1, Silke Walter, Mohammed Ghiath Shamdeen
1Acute Vascular Imaging Centre, Biomedical Research Centre, Oxford OX3 9DU, United Kingdom. i.grunwald@web.de
Insights
Innovative mechanical thrombectomy devices successfully restored blood flow in children with acute ischemic stroke. These treatments achieved excellent outcomes with no complications, improving neurological function.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
Background:
- Acute ischemic stroke in children requires effective reperfusion strategies.
- Mechanical thrombectomy offers a minimally invasive approach to clot removal.
Observation:
- Three pediatric patients (ages 7-16) with acute cerebral occlusions were treated.
- Devices used included the Penumbra System and Phenox clot retriever.
- Targeted vessels were the internal carotid, middle cerebral, and basilar arteries.
Findings:
- All patients achieved successful recanalization (thrombolysis in myocardial infarction [TIMI] 3).
- No device-related complications or intracranial hemorrhages were reported.
- Significant neurological improvement was observed, with National Institutes of Health Stroke Scale (NIHSS) score increases of 10-26 points.
Implications:
- Mechanical thrombectomy is a safe and effective treatment for pediatric acute ischemic stroke.
- These devices enable rapid recanalization and reduce bleeding risks compared to traditional therapies.
- Further research and guideline development are warranted for this emerging treatment modality.
Objective:
To evaluate the recanalization rate and clinical outcome in children with acute ischemic stroke following treatment with innovative mechanical thrombectomy devices.
Patients And Methods:
Three subjects aged 7-16 years presenting with acute cerebral vascular occlusions (thrombolysis in myocardial infarction [TIMI] 0) were treated with either the Penumbra System, operating on an aspiration platform, or the Phenox clot retriever device, a flexible wire compound with perpendicularly-oriented polyamid microfilaments. Target vessels were the internal carotid artery, the middle cerebral artery and the basilar artery.
Results:
Successful recanalization (TIMI 3) was attained in all cases. No device-related complications or intracranial hemorrhage occurred. Follow up was conducted for up to 30 days. A 10- to 26-point improvement in the National Institutes of Health Stroke Scale (NIHSS) score was achieved.
Conclusions:
Mechanical thrombectomy devices possess a dual advantage whereby they can achieve instant recanalization as well as minimize the number of bleeds that customarily accompany intravenous and intra-arterial therapy. These new devices could contribute greatly to treatment decisions in a field not yet clearly defined by current guidelines.
