Recurrent Large Vessel Occlusion in Two Different Vascular Territories Successfully Treated with Repeated Mechanical Thrombectomy on a Pediatric Patient: A Case Report
Ricardo Murguia Fuentes1, Jose Murguia Fuentes2, Himanshu Chokhawala3, Sheila Asghar4, Hugo Cuellar-Saenz1, J. Jordan1, Rosario Maria Riel-Romero5
1LSU Health Shreveport, 2Instituto Tecnologico Autonomo de Mexico, 3LSUHSC - SHreveport, 4Louisiana State University Health, 5Louisiana State University School of Medicine in Shreveport
Objective:
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Background:

Stroke is relatively rare in the pediatric population, but its consequences can turn into long-term neurological deficits and disability at the later life stages, with care costs that overcome the ones for adult patients and causing grievance to families. Hyperacute therapy for stroke is widely acknowledged and routinely performed in adults, but variations exist when extrapolating adult outcomes to children and not enough evidence has been documented. Despite no definitive data establishing a clear benefit for children, mechanical thrombectomy (MT) is a reasonable resource to treat large vessel occlusion in pediatric patients during the first 6 hours of symptom onset.

Design/Methods:
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Results:

An 11-year-old patient with history of prematurity, dilated cardiomyopathy (ejection fraction: 15%) with congenital complete heart block that required pacemaker and implantable cardiac defibrillator placement, presented to the emergency department due to becoming unresponsive, immobile, and not withdrawing to pain. This took place approximately 5 months after he had a left middle cerebral artery (LMCA) stroke. During the first event, he had right sided hemiparesis and aphasia with evidence of LMCA M1 occlusion which underwent MT with TICI2c reperfusion and almost full neurological recovery. At that time, a recent COVID-19 infection was reported and anticoagulation with warfarin was started. During the second event, a distal basilar artery occlusion was identified and both alteplase and thrombectomy were indicated, with TICI3 reperfusion, once again awakening and regaining consciousness and movement of his 4 extremities.

Conclusions:

To our best knowledge, this is the first documented case of pediatric stroke treated with repeated thrombectomy after recurrent large vessel occlusion in two different vascular territories, which matches the still scarce literature in adults on safety and efficacy of repeated mechanical thrombectomy. This case also highlights multiple pathophysiological and management dilemmas without clear consensus on the current literature, for which this case serves as reference.

10.1212/WNL.0000000000205468