Fibrin-Heparin-Coated Intracranial Stents as Salvage Therapy in Pediatric Focal Cerebral Arteriopathy-Inflammatory...

Area of Science:

• Neurology
• Pediatric Neurology
• Vascular Neurology

Background:

• Pediatric arterial ischemic stroke (AIS) is often linked to underlying arteriopathies.
• Focal cerebral arteriopathy of inflammatory type (FCA-i) is a rare cause of AIS in children.
• Progressive neurological deficits can occur despite standard medical management.

Purpose of the Study:

• To report a case of progressive AIS in a pediatric patient due to FCA-i.
• To evaluate the efficacy of endovascular therapy in managing this condition.
• To highlight diagnostic findings including vessel wall MRI and serological markers.

Main Methods:

• A 13-year-old male with progressive AIS underwent comprehensive medical therapy including antiplatelet agents, immunosuppressants, and antimicrobial treatment.
• Intra-arterial spasmolysis was administered due to vasospasm.
• Endovascular therapy involving balloon angioplasty and fibrin-heparin-coated intracranial stent placement was performed.
• Diagnosis was supported by vessel wall MRI and elevated Mycoplasma pneumoniae antibodies.

Main Results:

• The patient experienced clinical and radiographic deterioration despite initial medical treatments.
• Endovascular therapy resulted in successful revascularization and clinical stabilization.
• Vessel wall MRI and serological evidence confirmed FCA-i.
• Sustained stent patency and vascular improvement were observed at follow-up.
• Persistent distal upper-extremity-predominant hemiparesis remained.

Conclusions:

• Endovascular therapy can be a viable treatment option for pediatric AIS secondary to FCA-i when medical management fails.
• Vessel wall imaging and specific antibody testing are crucial for diagnosing FCA-i.
• While endovascular treatment can stabilize the condition, long-term neurological deficits may persist.