Superselective Intra-arterial Thrombolysis for Acute Cardioembolic Stroke in a Child with Idiopathic Dilated...

Area of Science:

• Neurology
• Cardiology
• Pediatrics

Background:

• Idiopathic dilated cardiomyopathy can present with embolic complications.
• Internal carotid artery occlusion in children is rare and can lead to severe ischemic stroke.
• Cardioembolic events require prompt diagnosis and management.

Purpose of the Study:

• To describe a case of successful superselective intra-arterial thrombolysis in a child with dominant hemisphere internal carotid artery occlusion.
• To highlight the management of cardioembolic stroke in a pediatric patient with underlying cardiomyopathy.
• To evaluate the long-term outcome of intra-arterial thrombolysis in this specific clinical scenario.

Main Methods:

• A pediatric patient with idiopathic dilated cardiomyopathy and acute dominant hemisphere internal carotid artery occlusion was treated.
• Superselective local intra-arterial thrombolysis was performed using recombinant tissue plasminogen activator (alteplase).
• Collateral flow was assessed, and post-interventional imaging was utilized to monitor for complications.

Main Results:

• Local intra-arterial thrombolysis prevented a major dominant hemisphere ischemic stroke due to good collateral flow.
• Post-intervention computed tomography revealed hemorrhagic conversion in the left corpus striatum.
• The patient achieved ambulatory status with a moderate neurologic deficit 48 months post-thrombolysis.

Conclusions:

• Superselective intra-arterial thrombolysis with alteplase can be an effective treatment for dominant hemisphere internal carotid artery occlusion in children with dilated cardiomyopathy.
• Careful monitoring for hemorrhagic complications is essential after thrombolysis.
• Long-term follow-up is crucial to assess functional outcomes in pediatric stroke patients.