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.
- pediatric stroke
- large vessel occlusion
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Contributors HS planned and conducted the research, reported the data and was responsible for writing and editing the manuscript. HS, AHS, EIL, CLK, TGJ, MRL, LJK, JG, ASP, JJG, TA, ASA, LE, DH, AC, AA, ES, RH, AJR, FAN, and PK collected the data and reviewed the manuscript. JM planned the research, edited and reviewed the manuscript and overall supervised the conduction of the research. HS and JM are the co-guarantors of the manuscript. We thank Roberta Santos for all of her contribution towards this study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All collected data was analyzed and reported. There are no additional unpublished data.
Correction notice Since this article was first published online, the affiliation for Andrew Ringer has been updated.
Patient consent for publication Not required.