Introduction The safety of using adult-sized thrombectomy devices in the smaller pediatric vasculature is a concern among stroke interventionalists. Here we measure vessel diameters in the cervical and cranial circulation in children to characterize when adult-approved devices might be compatible in children.
Methods For 54 children without vasculopathy (age: mean=9.5 ± 4.9 years, range=0.02–17.8 years; sex: 20F/34M) undergoing catheter angiography, the diameters of the large vessels in the cervical and cranial circulation (10 locations, 611 total measurements) were assessed by 3 radiologists. Intraclass correlation coefficient (ICC) was calculated. Mean±SD diameter was calculated for these age groups: 0–6 months; 1 year; and 2, 3, 4, 5–9, 10–14, and 15–18 years. To compare to adult sizes, each vessel measurement was normalized to the respective region mean diameter in children 15–18. Normalized measurements were plotted against age and fitted to a segmented regression, with breakpoint=5 years. Post-hoc, for each segment, age was also controlled for body mass index (BMI) using multivariate linear regression.
Results ICC ranged from 0.88 to 0.99. Vessel diameters increased rapidly between 0 to 5 years of age (slope=0.069/year) but changed minimally beyond that (slope=0.005/year) (Figure 1, R-square=0.2). The regression model predicted that, at 5 years of age, vessels would be 94% the diameter of the older age group (compared to 59% at birth). BMI was not significantly associated with vessel size in either age range. While smaller, vessels in children under 5 were hypothetically large enough to be compatible with adult devices in several cases (Table 1).
Conclusions From a size perspective, neurointerventionalists should consider patients 5 years and over as having vessels comparable to adults. Beyond 5 years, age alone should not be a contraindication to thrombectomy. Under 5 years, devices might still be compatible. BMI may not be as reliable as age when predicting vessel sizes in children.
Disclosures T. Ladner: None. L. He: None. S. Pruthi: None. M. Day: None. A. Desai: None. L. Jordan: None. M. Froehler: None.
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