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Updated: Mar 17, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical thrombectomy for pediatric acute ischemic stroke: review of the literature
Sudhakar Satti1, Jennifer Chen2, Thinesh Sivapatham1
1Department of Neurointerventional Surgery, Christiana Care Health System, Newark, Delaware, USA.
Insights
Mechanical thrombectomy for pediatric stroke shows high success rates in restoring blood flow and achieving good clinical outcomes. This intervention for acute ischemic stroke in children is promising despite small sample sizes.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Cerebrovascular Diseases
Background:
- Recent adult mechanical thrombectomy trials show positive outcomes.
- Pediatric stroke intervention literature requires comprehensive review, focusing on modern devices.
Purpose of the Study:
- To review available literature on intra-arterial pediatric stroke intervention.
- Focus on modern mechanical thrombectomy devices for acute ischemic stroke (AIS) in children.
Main Methods:
- PubMed search for pediatric AIS IA treatment using modern devices (2008-2015).
- Analysis included 29 pediatric patients.
- Data on patient demographics, occlusion sites, stroke severity, and intervention details were collected.
Main Results:
- High recanalization rates (75.9%) achieved with stent retrievers, Penumbra, and Merci devices.
- Excellent clinical outcomes with an average modified Rankin Scale (mRS) score of 0.86.
- No major adverse events related to intervention; one device malfunction occurred without long-term impact.
Conclusions:
- Mechanical thrombectomy is associated with high recanalization rates and excellent clinical outcomes in pediatric patients with high NIH Stroke Scale scores and large vessel occlusion.
- Endovascular treatment for pediatric AIS increases the chance of a good clinical outcome (Class IVC evidence).
- Further research with larger sample sizes is needed for definitive conclusions.
Objective:
Given recent strongly positive randomized controlled adult mechanical thrombectomy trials, we sought to perform a comprehensive review of available literature on IA pediatric stroke intervention, with a focus on modern mechanical devices.
Methods:
PubMed search for pediatric patients undergoing IA treatment of acute ischemic stroke (AIS) using modern devices between 2008 and 2015. 29 patients were included in this analysis.
Results:
Average age was 10.3 years, 74.1% male, middle cerebral and basilar arteries represented 89.6% of 36 occluded vessels, and average pediatric stroke scale score of 18.1. Average time from symptom onset to intervention was 8.8 hours and 13.8% of patients received IV tissue plasminogen activator prior to mechanical thrombectomy. Stent retrievers were used in 58.6% of cases, the Penumbra system in 34.5%, and the Merci device in 27.6%. Modified Thrombolysis In Cerebral Infarction 2b/3 recanalization was achieved in 75.9% of cases. There were no major adverse events related to the intervention, although one procedure was associated with device malfunction without a definite change in long-term outcome. The average modified Rankin Scale (mRS) score was <1 (0.86) at the longest available follow-up period, based on clinical description or provided mRS score.
Conclusions:
This study suggests that mechanical thrombectomy in pediatric patients presenting with high pediatric NIH Stroke Scale scores and proximal large vessel occlusion is associated with high recanalization rates and excellent clinical outcome, although this is a retrospective review and the sample size is too small to make any definitive conclusions. This study provides class IVC evidence that endovascular treatment of pediatric AIS increases the chance of a good clinical outcome.
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