The overwhelming benefit of endovascular therapy in patients with large-vessel occlusions suggests that more patients will be screened than treated. Some of those patients will be evaluated first at primary stroke centers; this type of evaluation calls for standardizing the imaging approach to minimize delays in assessing, transferring, and treating these patients. Here, we propose that CT angiography (performed at the same time as head CT) should be the minimum imaging approach for all patients with stroke with suspected large-vessel occlusion presenting to primary stroke centers. We discuss some of the implications of this approach and how to facilitate them.ABBREVIATIONS: CSC ϭ comprehensive stroke center; DIDO ϭ door-in-door-out time interval; EVT ϭ endovascular thrombectomy; LAMS ϭ Los Angeles Motor Scale; LVO ϭ large-vessel occlusion; PSC ϭ primary stroke center; P PSC 2P CSC ϭ picture at the primary stroke center to puncture at the comprehensive stroke center time
Pediatric ischemic stroke is an underOrecognized condition, frequently leading to delayed diagnosis. Most childhood strokes are due to intracranial arteriopathy, wherein mechanical thrombectomy is not applicable. Conversely, cardioembolic strokes may benefit from mechanical intervention, similarly to adults. Despite strong evidence for endovascular therapy in adults with acute ischemic stroke, limited data exist in children and adolescents.Methods: We performed a retrospective review of all cases of endovascular treatment of acute ischemic stroke in the pediatric population at our center between 2011 and 2018. Discussion/Conclusion: With the rise of mechanical trombectomy for the treatment of LVO stroke, increasing numbers of treated strokes in the pediatric population are expected. Mechanical thrombectomy seems safe and feasible in the pediatric population. Multidisciplinary selection of pediatric patients with LVO is warranted. Larger prospective studies are needed to validate these conclusions.
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