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Recurrent basilar artery thrombectomy for pediatric vertebral dissection: illustrative case
Jaclyn Meyer1, Stefanie Wood1, Siddhant Arora1
1Department of Neurology, School of Medicine, University of South Carolina, Columbia, South Carolina.
Insights
Mechanical thrombectomy effectively treats pediatric stroke, even for recurrent cases caused by vertebral artery dissection or aspirin resistance. This intervention offers significant benefits for children experiencing acute ischemic strokes.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Pediatric stroke is rare but carries a significant recurrence risk (5-19%).
- Delayed diagnosis in children contrasts with adult stroke management.
- Mechanical thrombectomy, a standard adult treatment, shows promise in pediatric patients.
Purpose of the Study:
- To report the successful management of a pediatric patient with recurrent basilar artery occlusions.
- To highlight the role of mechanical thrombectomy in treating pediatric stroke recurrence.
- To discuss treatment adjustments for vertebral artery dissection and aspirin resistance in pediatric stroke.
Main Methods:
- Case report of a 13-year-old male with recurrent basilar artery occlusions.
- Successful mechanical thrombectomy performed for two separate stroke events.
- Investigation revealed vertebral artery dissection with pseudoaneurysm.
- Antithrombotic therapy adjusted from aspirin to clopidogrel, then to apixaban.
Main Results:
- Initial thrombectomy led to significant neurological improvement.
- Second thrombectomy successfully treated recurrent stroke.
- Patient stabilized on apixaban without further stroke recurrence.
- Identified vertebral artery dissection and aspirin resistance as contributing factors.
Conclusions:
- Mechanical thrombectomy is effective for pediatric stroke, including recurrent cases.
- Repeat thrombectomy may be warranted for specific pediatric stroke etiologies.
- Vertebral artery dissection and aspirin resistance require tailored antithrombotic strategies in pediatric stroke.
Background:
Stroke is relatively uncommon in children, with a risk of recurrence ranging from 5% to 19%. Early diagnosis and treatment are critical for optimal recovery, but stroke in children is often identified later than in adults. While mechanical thrombectomy is a well-established standard treatment for acute ischemic strokes in adults, emerging data continue to show that this intervention can also benefit pediatric patients.
Observations:
This case report discusses the management of a 13-year-old male with recurrent basilar artery occlusions and an associated vertebral artery dissection. Initially presenting with acute ischemic stroke symptoms, the patient underwent a successful thrombectomy with significant improvement in neurological function. He experienced a second stroke due to another basilar artery occlusion, which was subsequently treated by a thrombectomy. Further investigation revealed a vertebral artery dissection with a pseudoaneurysm, likely contributing to the stroke recurrence. Treatment adjustments included transitioning from aspirin to clopidogrel when aspirin resistance concern was noted, and finally apixaban therapy when the dissection was discovered. The patient remained stable without stroke recurrence.
Lessons:
This case exemplifies the effectiveness of mechanical thrombectomy in pediatric stroke management and warrants further consideration for repeat procedures for recurrence due to insidious vertebral arterial dissections and those with aspirin resistance. https://thejns.org/doi/10.3171/CASE24523.
