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Published on: November 26, 2013
Non-routine thrombectomy in pediatric arterial ischemic stroke
Sinan Balcı1, Nesibe Gevher Eroğlu-Ertuğrul2, Ahmet Ziya Birbilen3
1Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye.
Insights
Mechanical thrombectomy for pediatric arterial ischemic stroke (AIS) often requires non-routine techniques. Specialized centers are crucial for adapting adult protocols to effectively treat children with AIS.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Mechanical thrombectomy indications and techniques for pediatric arterial ischemic stroke (AIS) are not well-established.
- Standard adult protocols may need modification for effective pediatric AIS management.
Purpose of the Study:
- To present six cases of pediatric arterial ischemic stroke (AIS) treated with non-routine mechanical thrombectomy.
- To highlight unique clinical and procedural aspects of pediatric AIS thrombectomy.
Main Methods:
- Retrospective review of pediatric AIS cases undergoing non-routine thrombectomy between 2015-2023.
- Evaluation of patient characteristics, procedural details, and clinical outcomes.
Main Results:
- Seven non-routine thrombectomy procedures were performed in six children.
- No procedure-related mortality or major neurologic morbidity; favorable modified Rankin Scale scores at follow-up.
- Included unique cases such as acute stent occlusion, bilateral carotid and MCA occlusions, and atrial myxoma embolism.
Conclusions:
- Mechanical thrombectomy in children with AIS may necessitate modifications to standard adult algorithms.
- Specialized pediatric centers are optimal for managing these complex cases.
Purpose:
Unlike in adults, the indications and techniques for mechanical thrombectomy for arterial ischemic stroke (AIS) in children are not clearly established. The medical and interventional management of children with acute large vessel occlusion may entail the modification of the standardized management of this condition in adults. We present six cases of children who underwent non-routine thrombectomy for AIS.
Methods:
We retrospectively reviewed the records of children diagnosed with AIS between 2015 and 2023 and evaluated patient characteristics, procedural technical data, and final clinical outcomes. Procedures deviating from the current definition and indications for AIS treatment in adults as well as previously reported pediatric thrombectomy cases were defined as non-routine thrombectomy.
Results:
Seven non-routine thrombectomy procedures in six children were included in the study. The National Institutes of Health Stroke Scale scores on admission ranged from 4 to 35; no procedure-related mortality or major neurologic morbidity occurred. One child died of causes related to the initial severe heart failure and stroke; otherwise, all the children had a modified Rankin scale score of 0 to 1 at follow-up. Unique clinical and procedural features in our case series included presentation with acute stent occlusion (two children), bilateral simultaneous internal carotid artery occlusions associated with a unilateral tandem middle cerebral artery (MCA) occlusion (one child), MCA occlusion caused by thromboembolism of the atrial myxoma (one child), and very distal (one child) or delayed thrombectomy (two children).
Conclusion:
Modifications to the standard medical and interventional algorithms may be required for mechanical thrombectomy in children.
Clinical Significance:
Referral centers specialized in pediatric neurology, pediatric anesthesia, and pediatric intervention are optimal for treating children using mechanical thrombectomy and for modifying the treatment, if required.
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