Intracranial Rescue Stenting in Pediatric Focal Cerebral Arteriopathy

Pediatric acute ischemic stroke is a rare yet severe condition with multifactorial etiology, often associated with vasculopathies. Endovascular intervention in children with focal cerebral arteriopathy is seldom reported.

Our aim was to report feasibility of intracranial rescue stenting for the management of pediatric focal cerebral arteriopathy with flow-limiting stenosis.

We report a toddler with acute ischemic stroke due to flow-limiting focal cerebral arteriopathy of the left middle cerebral artery, treated with intracranial stenting. A comprehensive literature search was conducted in PubMed, Web of Science, Embase, and Scopus to identify case reports and series involving pediatric patients with acute ischemic stroke treated with intracranial stenting. Six cases met inclusion criteria. Extracted data included demographics (age, sex), clinical presentation, time of onset, medical history, occlusion location and etiology, stent type, pre- and post-stent NIHSS scores, antiplatelet therapy, and clinical outcomes at follow-up.

A total of six pediatric acute ischemic stroke cases with intracranial stent deployment in the acute stage were analyzed. The supraclinoid internal carotid artery was the most common site of stent deployment (4/6), while intracranial dissection was the most frequent cause of vessel occlusion (3/6). All included patients achieved resolution of the initial neurological deficit on follow-up (range: 6 weeks to 6 months). Variation in the use of intraoperative and postoperative antiplatelet regimens was observed.

This case demonstrates off-label rescue stenting in pediatric acute ischemic stroke due to focal cerebral arteriopathy, emphasizing the importance of individualized multidisciplinary management in this rare setting.