Mechanical thrombectomy for pediatric acute stroke and ventricular assist device

Area of Science:

• Neurology
• Pediatric Stroke
• Interventional Neuroradiology

Background:

• Pediatric patients with cardiac disease or mechanical circulatory support, such as ventricular assist devices (VADs), face an elevated risk of ischemic stroke.
• Standard systemic thrombolysis is contraindicated in patients requiring chronic anticoagulation (e.g., VAD recipients), limiting acute ischemic stroke treatment options.
• Effective treatment strategies for acute ischemic stroke in this high-risk pediatric population remain limited.

Observation:

• A 9-year-old boy with a VAD presented with acute neurological deficits indicative of a severe stroke (pediatric NIHSS score of 23).
• Vessel imaging revealed a proximal left middle cerebral artery occlusion.
• The patient underwent successful mechanical thrombectomy within 4.5 hours of symptom onset.

Findings:

• Mechanical thrombectomy achieved complete removal of the occlusive thrombus.
• The patient demonstrated significant neurological improvement, with a pediatric NIHSS score of 3 at 72 hours post-procedure.
• This case is the third reported instance of successful mechanical thrombectomy for acute ischemic stroke in a pediatric VAD patient and the first utilizing the Trevo stent retriever system.

Implications:

• Mechanical thrombectomy, particularly with stent retriever systems, is a viable and effective treatment for acute ischemic stroke in pediatric VAD patients.
• This approach offers a critical therapeutic option for children experiencing acute neurological changes due to proximal vessel occlusion.
• Further research and case reports are warranted to establish mechanical thrombectomy as a standard treatment in this specialized population.