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Mechanical Thrombectomy in Pediatric Large Vessel Occlusions Before Cerebrovascular Maturity: A Case Report and
Nicholas P Derrico1, Rebekah Kimball1, Kristin Weaver1
1Neurosurgery, University of Mississippi Medical Center, Jackson, USA.
Insights
Endovascular thrombectomy successfully treated basilar artery occlusion in a two-year-old child. This case demonstrates modified techniques for pediatric stroke management, showing feasibility and good recovery.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Pediatric arterial ischemic stroke is uncommon but increasingly recognized.
- Endovascular thrombectomy is used off-label for large vessel occlusions in children, but evidence is limited.
- Cerebrovascular anatomy in children under five presents unique management challenges.
Observation:
- A case of cardioembolic basilar artery occlusion in a two-year-old is presented.
- The study details the technical aspects of endovascular management, addressing a gap in published literature.
- Modified techniques included using a 5 French slender sheath as a femoral short sheath and direct aspiration thrombectomy.
Findings:
- Successful endovascular management of basilar artery occlusion was achieved in a young child.
- The procedure utilized specific microcatheter and microwire navigation.
- No closure device was needed, and the patient experienced a near-complete, durable recovery.
Implications:
- Endovascular thrombectomy is feasible in small children with stroke, requiring adaptations to adult protocols.
- Pre-procedural imaging is crucial for tailoring aspiration systems to pediatric anatomy.
- This case provides valuable insights for managing pediatric large vessel occlusion stroke.
Abstract:
Pediatric arterial ischemic stroke is a rare but increasingly acknowledged disorder. Large vessel occlusions in this population have been treated off-label with endovascular thrombectomy. However, there is limited evidence to guide management. Small children, before the age of five when the cerebrovasculature reaches adult size, present additional challenges. We report the case of cardioembolic basilar occlusion in a two-year-old and the technical details of endovascular management, currently lacking in published literature. We employed a 5 French slender sheath, typically used for radial access, as a femoral short sheath. We accessed the dominant vertebral artery with a 5 French intermediate catheter, navigated with a typical 0.027-inch microcatheter and 0.014-inch microwire, and performed direct aspiration thrombectomy of the basilar clot. No closure device was employed. The patient had a near-complete and durable recovery. Small children present additional challenges for the endovascular management of stroke. Pre-procedural imaging can be used to design an aspiration-capable system appropriate for the child's size. Endovascular thrombectomy in children is feasible with some modifications to adult protocols.
