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

Huang, Yuchai; Wang, Zhen; Li, Changluo; Ding, Ning

doi:10.1097/md.0000000000021436

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…The 68 included articles 9–77 were published between 2001 and 2023 (Supporting Information S2: File 2). The main articles included case reports ( n = 48, 71 patients), prospective cohort studies ( n = 7, 215 patients), literature reviews ( n = 5), retrospective cohort studies ( n = 6, 209 patients), case series ( n = 1, nine patients), and systematic reviews ( n = 1, 235 patients).…”

Section: Resultsmentioning

confidence: 99%

“…Tables 1, 2, and 3 present the main characteristics of the interventions and the evaluated outcomes. There were 11 reports describing the use of IVT 10,12,17,18,22,25,32,44,49,51,77 ; eight reports of the use of the intra‐arterial modality; 9,12,14,20,21,26,27,58 and 52 articles reporting interventions based on MT 13,15,16,19,23,24,26,29–43,45–50,52–57,59,61,63–77 …”

Section: Resultsmentioning

confidence: 99%

“…There were 11 reports describing the use of IVT 10,12,17,18,22,25,32,44,49,51,77 ; eight reports of the use of the intra-arterial modality; 9,12,14,20,21,26,27,58 and 52 articles reporting interventions based on MT. 13,15,16,19,23,24,26,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][45][46][47][48][49][50][52][53][54][55][56]…”

Section: Synthesis Of Included Studiesmentioning

confidence: 99%

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A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

Garcia,

Zuliani,

Mendes‐Chillof

et al. 2023

Annals of the Child Neurology Society

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BackgroundManagement of pediatric stroke is challenging because of the paucity of data supporting the efficacy of interventions. This scoping review details the treatments available for the acute phase of stroke in pediatric patients with arterial ischemic stroke.Summary of ReviewOverall, 68 relevant articles were published between 2001 and 2023. The primary study included 48 case reports (n = 48). Eleven articles reported the use of intravenous thrombolysis (IVT) with alteplase, eight used intra‐arterial (IA) alteplase, and 52 reported mechanical thrombectomy (MT). IVT was administered to 195 patients with a median of 5.5 h of stroke onset, and only four (2.0%) had intracranial hemorrhage after alteplase treatment. Of the 11 articles, nine used 0.9 mg/kg IVT administered as a 10% bolus, with the remaining 90% administered over one hour, and one study used 0.54 mg/kg. IA was performed in 17 patients with a median of 5.05 h of stroke onset, and three individuals (17.6%) had intracranial hemorrhage. Of the eight reports that document IA, two used 0.9 mg/kg; one each used 0.16 mg/kg, 0.1 mg/kg, 0.6 mg/kg, 100 mg/day, and 10 mg/day; and one article documented the use of urokinase 750 000 IU. MT was used in 434 and 215 individuals in a previous systematic review, with a median of 11.82 h of stroke onset, and only 2.9% had intracranial hemorrhage after the treatment. Stent retrievers were used in 33 reports (63.5%) and aspiration retrievers were mentioned in 15 articles (28.8%). Overall, the outcomes ranged from complete to moderate recovery for all modalities.ConclusionsIVT and MT are safer than IA; however, despite the lack of clinical trials, all modalities seem effective in improving clinical recovery. To guide clinical practice and determine better intervention modalities, clinicians should note the key messages from this review, such as using magnetic resonance imaging in the acute phase and identifying key risk factors and presenting symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Synthesis Of Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

Garcia,

Zuliani,

Mendes‐Chillof

et al. 2023

Annals of the Child Neurology Society

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“…The patient and intervention characteristics are summarized in Table 1 . A total of 14 case reports with 21 cases (including the current report) were included in the review [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] .…”

Section: Discussionmentioning

confidence: 99%

Primary mechanical thrombectomy for anterior circulation stroke in children: Report of two cases and literature review

Christi

Suroto

Bajamal³

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Pediatric acute ischemic stroke is a rare but devastating condition with substantial rates of morbidity and mortality. Endovascular treatment is standard acute revascularization therapy for stroke in adults, but it is not well-studied in pediatrics. We report the successful treatment of two pediatric cases of anterior circulation stroke with primary mechanical thrombectomy. Case presentation Two Asian children, aged 13 and 8 years, presented to Dr. Soetomo General Academic Hospital in September 2020 and April 2021, respectively, with hemiplegia and significant Pediatric National Institutes of Health Stroke Scale (Ped NIHSS) scores. Head CT scans demonstrated hyperdense middle cerebral artery signs, suggesting large-vessel occlusion stroke. Both patients underwent emergent thrombectomy within 5 and 10 h after initial onset, and successful recanalization was achieved within an hour. Both demonstrated good neurological recovery and there was no recurrent stroke during follow-up. Clinical discussion Thrombectomy has appeal for childhood acute ischemic stroke (AIS) due to a longer post-stroke time window for intervention. As the short-term outcome, a significantly reduced Ped NIHSS score is achieved. Long-term outcomes are measured by modified Rankin Scale (mRS) scores. A literature review from 2016 to 2021 yielded 21 pediatric case reports of primary mechanical thrombectomy for anterior circulation stroke (including the present cases). We compare our cases with the published literature to discuss the short-term and long-term outcomes. Conclusion Mechanical thrombectomy holds promise as a treatment modality in pediatric AIS. These case reports described successful primary mechanical thrombectomy for AIS treatment in children.

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“…As the administration of a thrombolytic therapy may increase the risk of intracranial hemorrhage in children, a pediatric hematologist, in addition to a neurologist, should be included in the assessment of therapeutic possibilities. Recent research, based predominately on the case reports or the case series, suggest that endovascular treatment in children seems to be a feasible and safe treatment with favourable outcomes [163][164][165][166]. Thrombectomy, in order to establish revascularization, has been performed in cases of a large vessel occlusion in children, and has had a good neurological outcome [159].…”

Section: Up-and-coming Therapeutic Modalities and Approachesmentioning

confidence: 99%

The Genetic Basis of Strokes in Pediatric Populations and Insight into New Therapeutic Options

Janković

Petrović²,

Novaković

et al. 2022

IJMS

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Strokes within pediatric populations are considered to be the 10th leading cause of death in the United States of America, with over half of such events occurring in children younger than one year of life. The multifactorial etiopathology that has an influence on stroke development and occurrence signify the importance of the timely recognition of both modifiable and non-modifiable factors for adequate diagnostic and treatment approaches. The early recognition of a stroke and stroke risk in children has the potential to advance the application of neuroprotective, thrombolytic, and antithrombotic interventions and rehabilitation strategies to the earliest possible timepoints after the onset of a stroke, improving the outcomes and quality of life for affected children and their families. The recent development of molecular genetic methods has greatly facilitated the analysis and diagnosis of single-gene disorders. In this review, the most significant single gene disorders associated with pediatric stroke are presented, along with specific therapeutic options whenever they exist. Besides monogenic disorders that may present with stroke as a first symptom, genetic polymorphisms may contribute to the risk of pediatric and perinatal stroke. The most frequently studied genetic risk factors are several common polymorphisms in genes associated with thrombophilia; these genes code for proteins that are part of the coagulation cascade, fibrolysis, homocystein metabolism, lipid metabolism, or platelets. Single polymorphism frequencies may not be sufficient to completely explain the stroke causality and an analysis of several genotype combinations is a more promising approach. The recent steps forward in our understanding of the disorders underlying strokes has given us a next generation of therapeutics and therapeutic targets by which to improve stroke survival, protect or rebuild neuronal connections in the brain, and enhance neural function. Advances in DNA sequencing and the development of new tools to correct human gene mutations have brought genetic analysis and gene therapy into the focus of investigations for new therapeutic options for stroke patients.

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

Cited by 4 publications

References 29 publications

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

Primary mechanical thrombectomy for anterior circulation stroke in children: Report of two cases and literature review

The Genetic Basis of Strokes in Pediatric Populations and Insight into New Therapeutic Options

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