Endovascular Therapies for Acute Ischemic Stroke in Children

Cobb, Mary In-Ping Huang; Laarakker, Avra S.; Gonzalez, L. Fernando; Smith, Tony P.; Hauck, Erik F.; Zomorodi, Ali R.

doi:10.1161/strokeaha.117.016887

Cited by 30 publications

(36 citation statements)

References 38 publications

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“…Procedure related complications were reported in two cases in this analysis, yielding a complication rate of 18%, which is similar to the 14% rate in a previous analysis of all pediatric patients who underwent MT for acute stroke 5. The first was asymptomatic possible intracranial hemorrhage (could not be distinguished from contrast extravasation) in a child who had also received IV tPA 19.…”

Section: Discussionsupporting

confidence: 80%

Endovascular mechanical thrombectomy for acute stroke in young children

Sun

Felling

Pearl

2019

J NeuroIntervent Surg

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BackgroundMechanical thrombectomy has emerged as a standard of care for acute stroke from large vessel occlusion in adults but remains controversial in children. Cerebral vessels are nearly adult size by 5 years of age but the technical feasibility of achieving recanalization in younger and smaller children with current endovascular tools remains unclear.ObjectiveTo systematically review the literature on mechanical thrombectomy for stroke in children less than 5 years of age.ResultsMechanical thrombectomy for acute stroke has been reported in 11 children under the age of 5 years (range 9 months to 4 years). The mean time from symptom onset to groin puncture was 12 hours (range 4–50 hours). Complete recanalization was achieved in 7/12 (58%) vessels attempted, and partial recanalization in 4/12 (33%). Two procedure related complications were reported, with small vessel size felt to be contributory to basilar vasospasm in one case. Favorable neurological outcomes were reported in 7 cases (64%).ConclusionsOur review of the literature demonstrates that mechanical thrombectomy for acute ischemic stroke may be feasible in carefully selected infants and young children less than 5 years of age using currently available devices. Efficacy in promoting better neurologic outcomes remains unproven, and other questions persist, including whether complications such as vasospasm occur more frequently in young children compared with adults. Further study is needed to determine the safety and efficacy of pediatric mechanical thrombectomy. These data suggest that young children should not be excluded from future studies or clinical treatment on the basis of age alone.

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Section: Discussionsupporting

confidence: 80%

Endovascular mechanical thrombectomy for acute stroke in young children

Sun

Felling

Pearl

2019

J NeuroIntervent Surg

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“…We noted low utilization of IA tPA compared with previous reports. A review of all pediatric AIS cases treated with endovascular therapy between 1990 and 2016 showed that 35.3% of patients were treated with IA thrombolysis only, and 34.1% of patients treated with mechanical devices also had adjuvant IA thrombolytics 4. In this series, no patient was treated with primary IA tPA and only 22.2% of patients received adjuvant IA tPA.…”

Section: Discussionmentioning

confidence: 80%

“…In this series, no patient was treated with primary IA tPA and only 22.2% of patients received adjuvant IA tPA. Overall, the revascularization rate was 89.5% compared with previous studies in which revascularization was achieved in 67.2% of patients treated with all modalities4 and 75.9–79.1% of patients treated with mechanical thrombectomy 4 6…”

Section: Discussionmentioning

confidence: 80%

Endovascular thrombectomy in pediatric patients with large vessel occlusion

Shoirah

Shallwani

Siddiqui

et al. 2019

J NeuroIntervent Surg

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BackgroundPediatric acute ischemic stroke with underlying large vessel occlusion is a rare disease with significant morbidity and mortality. There is a paucity of data about the safety and outcomes of endovascular thrombectomy in these cases, especially with modern devices.MethodsWe conducted a retrospective review of all pediatric stroke patients who underwent endovascular thrombectomy in nine US tertiary centers between 2008 and 2017.ResultsNineteen patients (63.2% male) with a mean (SD) age of 10.9(6) years and weight 44.6 (30.8) kg were included. Mean (SD) NIH Stroke Scale (NIHSS) score at presentation was 13.9 (5.7). CT-based assessment was obtained in 88.2% of the patients and 58.8% of the patients had perfusion-based assessment. All procedures were performed via the transfemoral approach. The first-pass device was stentriever in 52.6% of cases and aspiration in 36.8%. Successful revascularization was achieved in 89.5% of the patients after a mean (SD) of 2.2 (1.5) passes, with a mean (SD) groin puncture to recanalization time of 48.7 (37.3) min (median 41.5). The mean (SD) reduction in NIHSS from admission to discharge was 10.2 (6.2). A good neurological outcome was achieved in 89.5% of the patients. One patient had post-revascularization seizure, but no other procedural complications or mortality occurred.ConclusionsEndovascular thrombectomy is safe and feasible in selected pediatric patients. Technical and neurological outcomes were comparable to adult literature with no safety concerns with the use of standard adult devices in patients as young as 18 months. This large series adds to the growing literature but further studies are warranted.

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“…[ 25 ] Another research about 68 pediatric patients revealed that mechanical thrombectomy group had better neurological outcome and clinical prognosis with fewer complications compared to intravenous thrombolysis group. [ 26 ] Even one case reported that a 2-year-old male patient with AIS was performed for mechanical thrombectomy successfully and recovered well. [ 27 ] However, there was still very low incidence of complications such as cerebral hemorrhage and orolingual angioedema in some cases, [ 28 , 29 ] and the treatment of children with AIS needs to be further explored with large samples.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy for a 12-year-old boy with acute ischemic stroke

Huang

Wang

et al. 2020

Medicine

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Rationale: Acute ischemic stroke (AIS) is one of the most severe diseases that endanger human health. It is very common among middle-aged and elderly people, but it is rare in children. The treatment varies among children and adults, since the cause for AIS in children differs from that in adults. In adults with AIS, endovascular therapy has been recommended, but guidelines for endovascular therapy in children with AIS have not been established yet. In China, few relevant evidence is present so far in clinical research of mechanical thrombectomy in the treatment for children with AIS. Patient concerns: A 12-year-old boy without any special physical collision and trauma was admitted to emergency department of Changsha central hospital due to hemiplegia of left limbs for 3 hours. Diagnoses: He was diagnosed with AIS after magnetic resonance imaging (MRI) examination and magnetic resonance angiography (MRA) examination. Cerebral infarction in the right parietal, temporal, insular, and frontal lobes was revealed by the MRI test. The MRA test detected occlusions in right internal carotid artery, A1 segment of right anterior cerebral artery, right middle cerebral artery, and distal branch. Interventions: Mechanic thrombectomy and antiplatelet aggregation therapy with clopidogrel helped the patient to recover, along with active rehabilitation training. Outcomes: A significant improvement in muscle strength of his left limbs was proved. He walked by himself and had 2 of Modified Rankin Scale (MRS). At 1-year follow-up visit, he recovered well except feeling a bit pain of left lower limb when walking, with finally MRS of 1. Conclusions: Mechanical thrombectomy can be performed safely for children with AIS, but needs a further research with large samples.

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Endovascular Therapies for Acute Ischemic Stroke in Children

Cited by 30 publications

References 38 publications

Endovascular mechanical thrombectomy for acute stroke in young children

Endovascular mechanical thrombectomy for acute stroke in young children

Endovascular thrombectomy in pediatric patients with large vessel occlusion

Mechanical thrombectomy for a 12-year-old boy with acute ischemic stroke

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