Acute Ischemic Stroke Large Vessel Occlusion treated with Mechanical Thrombectomy in the Pediatric Populatio
Jessica Glenn1, Vivien Lee2, Shahid Nimjee1, Warren Lo3, cassandra forrest1, Randheer Yadav1, Patrick Youssef1
1OSUWMC, 2OSU Comprehensive Neurovascular Center, 3Nationwide Childrens Hospital
Objective:
We sought to assess the safety and efficacy of mechanical thrombectomy performed in children at our institution for acute ischemic stroke (AIS) due to large vessel occlusion (LVO).
Background:
AIS due to large vessel occlusion (LVO) is relatively rare in the pediatric population, and evidence supporting thrombectomy in children is limited. The use of thrombectomy in the pediatric population is extrapolated from data in the adult stroke literature.
Design/Methods:
We performed a retrospective chart review of pediatric patients (age < 18 years) with AIS due to LVO who underwent thrombectomy at our comprehensive academic stroke center from January 2019 to June 2022.
Results:
We identified 4 cases of pediatric AIS with LVO treated with thrombectomy. The mean age was 12 years old (range, 9-17), 3 were males. The mean National Institutes of Health Stroke Scale was 16 (range, 10 to 28). One patient received partial thrombolysis (aborted with 20% of dose received). Prior to thrombectomy, 1 patient had CT brain perfusion which showed MCA mismatch favorable for thrombectomy, whereas the remaining 3 patients had MRI brain showing acute infarct in the territory of LVO. LVO sites included M1 occlusion (2), carotid T occlusion (1), and M2 occlusion (1). All 4 patients had successful revascularization including 3 patients with thrombolysis in cerebral infarction (TICI) 3 and 1 patient with TICI 2b. There were no symptomatic hemorrhages. The mean time from last known normal to groin puncture was 5.7 hours (range, 2.9 to 9.2). The clinical outcomes included 2 patients with modified rankin scores (mRS) 1 and 2 patients with mRS 3.
Conclusions:
In our case series of pediatric AIS cases with LVO, thrombectomy was feasible and associated with successful revascularization. There were no safety concerns. The majority of cases were diagnosed by MRI brain, highlighting the difficulty in diagnosis of LVO in the pediatric population.