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Thrombectomy for a basilar artery occlusion in a 2-year-old child: A focus on anatomical and technical aspects
Răzvan Alexandru Radu1, Vincent Costalat1, Paolo Machi2
1Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Insights
Endovascular treatment (EVT) is safe and effective for acute ischemic stroke in children, even in late windows. A 2-year-old successfully underwent EVT for basilar occlusion using a 6-Fr femoral approach.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Vascular Medicine
Background:
- Endovascular treatment (EVT) for pediatric acute ischemic stroke is debated due to limited data and concerns about vessel development.
- Current guidelines are cautious for children under 5, lacking robust evidence on EVT safety and efficacy in this age group.
Purpose of the Study:
- To evaluate the safety and efficacy of late-window EVT in a 2-year-old child with basilar artery occlusion.
- To provide insights into pediatric endovascular device compatibility and vessel development for EVT procedures.
Main Methods:
- Case report of a 2-year-old child with basilar occlusion undergoing late-window EVT.
- Utilized a 6-Fr femoral introducer, 6-Fr guide catheter, and 5-Fr aspiration catheter for the procedure.
- Reviewed literature on normal cerebral and femoral vessel development and device compatibility by age.
Main Results:
- Successful late-window EVT was performed in a 2-year-old child with basilar occlusion.
- The procedure was safely accomplished using standard 6-Fr and 5-Fr endovascular devices via a femoral approach.
- Analysis suggests that children with normal arterial development can tolerate a 6-Fr femoral approach by age 2.
Conclusions:
- Endovascular treatment (EVT) is a safe and effective option for acute ischemic stroke in children, including in late-window scenarios.
- Pediatric patients, even as young as 2 years old with normal vessel development, can safely undergo EVT using currently available devices.
- Further research and data are needed to solidify guidelines for EVT in pediatric stroke, but case evidence supports its use.
Abstract:
Endovascular treatment (EVT) for large vessel, acute ischemic stroke in children remains a subject of debate, with evidence for its benefits derived from case series and individual case reports. At present, guidelines are cautious in recommending EVT for children under 5 years of age, mainly due to a lack of data and incomplete cerebral and femoral vessel development. However, based on the small number of cases reported in the literature, EVT appears to be safe and effective for pediatric use and arterial diameters can accommodate currently available devices. Available evidence shows that in patients with a normal arterial development, a 6-Fr femoral approach can be safely used by 2 years of age. We describe the case of a 2-year-old child who benefited from late-window EVT for a basilar occlusion. The procedure was safely performed using a 6-Fr femoral introducer, a 6-Fr guide catheter, and a 5-Fr aspiration catheter. We discuss also normal cerebral and femoral vessel development, providing descriptive tables of compatibility between femoral and cerebral arterial diameters by age groups and currently available endovascular devices.
