Mechanical thrombectomy for acute stroke in childhood: how much does restricted diffusion matter?

Area of Science:

• Neurology
• Pediatric Stroke
• Interventional Neuroradiology

Background:

• Large cerebral arterial occlusions (LCAOs) in children are rare but can lead to severe disability.
• Mechanical thrombectomy (MT) is an established treatment for acute ischemic stroke in adults, but data in pediatric populations are limited.
• Early reperfusion is critical for improving outcomes in acute ischemic stroke.

Observation:

• A 5-year-old presented with a basilar artery occlusion (BAO) with extensive diffusion-weighted imaging (DWI) restriction.
• The patient underwent successful retrievable stent-assisted mechanical thrombectomy.
• Successful reperfusion (Thrombolysis in Cerebral Infarction 2B) was achieved despite a late presentation.

Findings:

• The patient experienced an excellent clinical outcome with no residual deficits at 6-week follow-up (pediatric stroke outcome measure=0, modified Rankin scale=0).
• No recurrent stroke or stroke-like symptoms were reported at 3-month follow-up.
• This case highlights the potential efficacy of MT in pediatric stroke.

Implications:

• Mechanical thrombectomy is a viable and effective treatment option for children with basilar artery occlusion and LCAO.
• Further research and case reports are needed to establish MT guidelines for pediatric stroke.
• Successful MT in pediatric stroke can lead to complete functional recovery and improved long-term outcomes.