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Published on: December 19, 2025
Experience of mechanical thrombectomy for paediatric arterial ischaemic stroke
Caroline Bodey1, Tony Goddard2, Tufail Patankar2
1Yorkshire Deanery, UK.
Insights
Mechanical thrombectomy may be a viable treatment for pediatric arterial ischemic stroke (AIS) in UK children with large vessel occlusion. This study reports on the first UK series of mechanical thrombectomy outcomes in children with AIS.
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neuroradiology
Background:
- Pediatric arterial ischemic stroke (AIS) is a significant cause of childhood morbidity and mortality.
- Current guidelines do not recommend thrombectomy for pediatric AIS.
- Mechanical thrombectomy has been performed in children at our institution for large vessel occlusion.
Purpose of the Study:
- To report the first series of mechanical thrombectomy and outcomes in pediatric AIS patients in the UK.
- To evaluate the feasibility and safety of endovascular clot retrieval in children with AIS.
Main Methods:
- Retrospective review of four pediatric AIS patients (5-15 years) with high PedNIHSS scores (>17).
- Endovascular management including mechanical thrombectomy for large vessel occlusion (basilar artery or middle cerebral artery).
- Assessment of procedural success, complications, and functional outcomes using the modified Rankin Scale (MRS).
Main Results:
- Three patients had basilar artery occlusion, and one had left middle cerebral artery occlusion.
- All thrombectomies were uncomplicated; one required a second attempt.
- Thrombectomy times ranged from <6 hours to 17-36 hours post-symptom onset.
- Modified Rankin Scale scores were 0-3, with 50% achieving a score of 0.
Conclusions:
- Mechanical thrombectomy may be effective in selected pediatric AIS patients with large vessel occlusion.
- An experienced multidisciplinary team is crucial for successful management.
- Further data collection is essential to establish evidence for thrombectomy in pediatric AIS.
Background:
Paediatric arterial ischaemic stroke (AIS) is an important cause of acute neurological symptoms in children, it causes significant morbidity and is one of the top ten causes of childhood deaths. Consensus papers have suggested guidelines for the management of AIS in childhood, although none recommend thrombectomy. Despite this, children within our institution have undergone mechanical thrombectomy for large vessel occlusion. This is the first series of mechanical thrombectomy and outcomes performed in children in the U.K.
Methods:
We describe the endovascular management of paediatric arterial ischaemic stroke (AIS) in four children (5-15 years) with PedNIHSS > 17.
Results:
Three had basilar artery (BA) occlusion and one left middle cerebral artery (MCA) occlusion. All underwent uncomplicated thrombectomy followed by intravenous heparin. One had a successful second attempt. The BA cases underwent thrombectomy 17-36 h after symptom onset; the left MCA case <6 h after symptom onset. Modified Rankin Scale (MRS) was 0-3, 50% had MRS 0.
Discussion:
Adult AIS guidelines recommend IV recombinant tissue plasminogen activator (r-tPA) within 4.5 h of onset and intra-arterial r-tPA within 6 h; thrombectomy being reserved for carefully selected patients. Paediatric AIS recognition is problematic, often with delayed imaging. There is little evidence regarding efficacy of thrombectomy for paediatric AIS. Our experience suggests there may be a role for endovascular clot retrieval in selected patients managed by an experienced multidisciplinary team. Careful data collection is mandatory.
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