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Updated: Nov 2, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Case Report: Late Successful Thrombectomy for Ischemic Stroke in a 2-Year-Old Child
Nathalie Nasr1, Louis Delamarre2, Emmanuel Cheuret3
1Department of Neurology, Toulouse University Hospital, Université Toulouse III, INSERM UMR 1048, Toulouse, France.
Insights
Mechanical thrombectomy successfully treated a 2-year-old
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neurology
Background:
- Mechanical thrombectomy is established for adult large-vessel occlusion ischemic stroke within 6 hours.
- Its efficacy in very young children, especially beyond the 6-hour window, remains less understood.
Observation:
- A 2-year-old female presented with acute ischemic stroke symptoms, including right hemiplegia and speech difficulties.
- Imaging revealed a middle cerebral artery (MCA) occlusion with limited early ischemic changes (ASPECTS 8).
- The stroke etiology was identified as an embolic thrombus secondary to congenital heart disease.
Findings:
- Successful mechanical thrombectomy was performed 9 hours after stroke onset.
- Complete recanalization (TICI 3) was achieved using a stent retriever under general anesthesia.
- The patient experienced a complete clinical recovery with no neurological deficits at 3 months (PedNIHSS 0, mRS 0).
Implications:
- This case suggests that mechanical thrombectomy can be a viable treatment option for acute ischemic stroke in very young children, even beyond 6 hours.
- A cardioembolic etiology may be a favorable factor for successful thrombectomy outcomes in pediatric stroke.
- Highlights the importance of individualized treatment decisions in pediatric stroke management.
Abstract:
Despite extensive evidence of benefit of thrombectomy in adult ischemic stroke due to large-vessel occlusion in the 6-h window, its role remains uncertain in very young children. We describe hereafter the case of a 2-year-old female child who had a successful thrombectomy 9 h after stroke onset. The patient presented with right hemiplegia, central facial palsy, a normal level of consciousness, and speech difficulties. The PedNIHS score was 11. CT scan without contrast injection displayed spontaneous hyperdensity of the middle cerebral artery (MCA), with only limited early signs of ischemia (ASPECTS 8). CT angiography demonstrated occlusion of the proximal MCA with good collaterals. Thrombectomy was realized. Complete recanalization (TICI 3) was obtained under general anesthesia after two passes of a stent retriever. Time from symptoms onset to full recanalization was 9 h. The acute ischemic stroke was caused by embolic thrombus from a congenital heart disease. Clinical recovery was complete. Three months after the thrombectomy, the young patient was doing well without any neurological sequelae (PedNIHSS 0; modified Rankin Scale: 0). This case report is an example of a decision-making process to perform thrombectomy in a very young child, which included cardio-embolic etiology as a parameter that potentially might have participated to the successful outcome of the therapeutic procedure.
