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J Neurointerv Surg. 2019 Jul;11(7):729-732. doi: 10.1136/neurintsurg-2018-014320. Epub 2019 Mar 6.

Endovascular thrombectomy in pediatric patients with large vessel occlusion.

Author information

1
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
2
Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA.
3
Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
4
Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
5
Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA.
6
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
7
Radiology, University of Michigan, Ann Arbor, Michigan, USA.
8
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
9
Department of Radiology and Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
10
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
11
UT Department of Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA.
12
Semmes-Murphey Clinic, Memphis, Tennessee, USA.
13
Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA.
14
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
15
Department of Neurology, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA.
16
Department of Neurosurgery, Ohio State University, Columbus, Ohio, USA.
17
Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA.
18
Mayfield Clinic, TriHealth Neuroscience Institute, Good Samaritan Hospital, Cincinnati, Ohio, USA.
19
Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
20
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
21
The Mount Sinai Health System, New York, New York, USA.

Abstract

BACKGROUND:

Pediatric 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.

METHODS:

We conducted a retrospective review of all pediatric stroke patients who underwent endovascular thrombectomy in nine US tertiary centers between 2008 and 2017.

RESULTS:

Nineteen 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.

CONCLUSIONS:

Endovascular 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.

KEYWORDS:

large vessel occlusion; pediatric stroke; thrombectomy

PMID:
30842301
DOI:
10.1136/neurintsurg-2018-014320
[Indexed for MEDLINE]

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