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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Extended time window mechanical thrombectomy for pediatric acute ischemic stroke.

Yolanda Aburto-Murrieta1, Beatriz Méndez1, Juan M Marquez-Romero2

  • 1Departamento de Terapia Endovascular Neurológica, Instituto Nacional de Neurología y Neurocirugía, "MVS", CDMX, Mexico.

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Summary

Extended window endovascular thrombectomy (EVT) shows promise for pediatric acute ischemic stroke (AIS), achieving high recanalization and good clinical outcomes. However, evidence strength is low due to study limitations.

Keywords:
Pediatricendovascularstrokethrombectomy

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Area of Science:

  • Neurology
  • Pediatric Stroke
  • Interventional Neuroradiology

Background:

  • Endovascular thrombectomy (EVT) is underutilized in pediatric acute ischemic stroke (AIS), particularly beyond the 6-hour window.
  • Limited data exists on the efficacy and safety of extended window EVT in children.

Purpose of the Study:

  • To review published literature on extended window EVT for pediatric AIS.
  • To assess outcomes including recanalization rates and clinical results.

Main Methods:

  • Systematic literature search of PubMed for pediatric AIS cases and case series treated with extended window EVT.
  • Analysis of 38 cases from 27 publications.

Main Results:

  • Median age 10 years, median NIHSS 13, median treatment time 11 hours.
  • High rates of successful reperfusion (TICI ≥2B in 84.2%) and favorable clinical outcomes (84.2%) were observed.
  • Posterior circulation strokes were common (50.0%).

Conclusions:

  • Extended window EVT demonstrates potential for high recanalization and good clinical outcomes in pediatric AIS.
  • The current evidence is of low strength due to indirect data and inconsistencies.
  • Further high-quality research is needed to confirm these findings.