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Updated: Mar 20, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Considerations in Applying a New Stent Retriever in Pediatric Endovascular Cerebral Thrombectomy for Acute Ischemic
Alfred P See1, Michael A Kochis, Priyank Khandelwal
1Department of Neurosurgery, Boston Children's Hospital, Boston, Mass., USA.
Insights
Pediatric acute ischemic stroke (AIS) treatment is challenging. A new, smaller stent retriever shows promise for safely and effectively treating AIS in children, addressing concerns about device size mismatch.
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neuroradiology
Background:
- Acute ischemic stroke (AIS) in children presents unique diagnostic and therapeutic challenges.
- Endovascular thrombectomy, successful in adults, is increasingly applied to pediatric AIS.
- Concerns exist regarding the safety and efficacy of adult-designed devices in pediatric patients due to potential vessel-to-device size mismatch.
Observation:
- A newer-generation, smaller stent retriever was utilized in pediatric stroke cases.
- This device is designed for delivery through smaller, more navigable microcatheters compared to older devices.
Findings:
- The smaller stent retriever was successfully applied in pediatric stroke cases.
- This suggests a potential solution to the vessel-to-device size mismatch issue in pediatric endovascular treatment.
Implications:
- This advancement may improve the safety and efficacy of endovascular thrombectomy for pediatric AIS.
- Further research is warranted to validate these findings and establish optimal use protocols for pediatric stroke intervention.
Abstract:
Acute ischemic stroke (AIS) in children has been difficult to diagnose, treat and study, due to atypical clinical presentation, imaging challenges and the rarity of large-vessel embolic occlusion as the etiology of acute neurological change in children. With endovascular thrombectomy showing success in randomized trials of adult AIS, the technique is increasingly being extrapolated to pediatric stroke. However, there is little evidence regarding the safety or efficacy of applying in children these devices developed and tested in adults. There is concern about a vessel-to-device size mismatch that may result in a different complication and benefit profile than typically seen. We report on the successful application in pediatric stroke of a newer-generation, smaller stent retriever, designed to be delivered through relatively smaller and more navigable microcatheters than the prior generation of this device.
