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Mechanical thrombectomy versus medical management for pediatric ischemic stroke: a systematic review and

Alperen Elek1, Cem Bilgin2, Sherief Ghozy2

  • 1Faculty of Medicine, Ege University, Izmir, Turkey.

Journal of Neurointerventional Surgery
|February 18, 2026
PubMed

Insights

Mechanical thrombectomy (MT) shows promise for pediatric ischemic stroke, improving functional outcomes compared to medical management (MM). This analysis highlights MT

Area of Science:

  • Pediatric Neurology
  • Interventional Neuroradiology
  • Stroke Medicine

Background:

  • Ischemic stroke is a significant cause of disability and death in children.
  • Mechanical thrombectomy (MT) is not yet approved for pediatric use, unlike in adults.
  • Existing data on pediatric MT safety and efficacy are limited.

Purpose of the Study:

  • To evaluate the safety and effectiveness of mechanical thrombectomy (MT) in pediatric ischemic stroke.
  • To compare MT outcomes with medical management (MM) in children.
  • To synthesize current evidence on MT for pediatric stroke.

Main Methods:

  • A systematic literature search was conducted across MEDLINE, Scopus, and Web of Science.
  • Studies reporting outcomes for MT, with or without intravenous thrombolysis (IVT), in pediatric ischemic stroke were included.
  • Data from MM arms within comparative studies were also extracted.

Main Results:

  • The meta-analysis included 18 studies with 612 pediatric patients.
  • Successful recanalization (TICI 2b-3) was achieved in 88.9% of MT patients; complete recanalization (TICI 3) in 43.9%.
  • Favorable functional outcomes (mRS 0-2) were observed in 78.6%, with low rates of mortality (3.9%) and symptomatic intracranial hemorrhage (sICH) (1.3%).
  • MT demonstrated a significant improvement in functional outcomes compared to MM (OR, 0.43; P<0.001).

Conclusions:

  • Mechanical thrombectomy appears to be a safe and effective treatment for pediatric ischemic stroke.
  • MT offers a more favorable functional outcome profile compared to medical management in this population.
  • Further research is warranted to identify specific pediatric patient subgroups who would most benefit from MT.
Abstract

Keywords:
PediatricsStrokeThrombectomy

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