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Clinical Neurology
Case report
Endovascular thrombectomy in pediatric patients with large vessel occlusion
  1. Hazem Shoirah1,
  2. Hussain Shallwani2,
  3. Adnan H Siddiqui3,
  4. Elad I Levy2,
  5. Cynthia L Kenmuir4,
  6. Tudor G Jovin4,
  7. Michael R Levitt5,
  8. Louis J Kim6,
  9. Julius Griauzde7,
  10. Aditya S Pandey8,
  11. Joseph J Gemmete9,
  12. Todd Abruzzo10,
  13. Adam S Arthur11,
  14. Lucas Elijovich12,
  15. Daniel Hoit13,
  16. Ahmed Cheema14,
  17. Amin Aghaebrahim15,
  18. Eric Sauvageau16,
  19. Ricardo Hanel17,
  20. Andrew J Ringer18,
  21. Fábio A Nascimento19,
  22. Peter Kan20,
  23. J Mocco21
    1. 1 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
    2. 2 Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
    3. 3 Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
    4. 4 Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    5. 5 Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA
    6. 6 Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
    7. 7 Radiology, University of Michigan, Ann Arbor, Michigan, USA
    8. 8 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
    9. 9 Department of Radiology and Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
    10. 10 Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
    11. 11 UT Department of Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
    12. 12 Semmes-Murphey Clinic, Memphis, Tennessee, USA
    13. 13 Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA
    14. 14 Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
    15. 15 Department of Neurology, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
    16. 16 Department of Neurosurgery, Ohio State University, Columbus, Ohio, USA
    17. 17 Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
    18. 18 Mayfield Clinic, TriHealth Neuroscience Institute, Good Samaritan Hospital, Cincinnati, Ohio, USA
    19. 19 Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
    20. 20 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
    21. 21 The Mount Sinai Health System, New York, New York, USA
    1. Correspondence to Dr Hazem Shoirah, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York NY 10036, USA; hazem.shoirah{at}mountsinai.org

    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.

    • pediatric stroke
    • thrombectomy
    • large vessel occlusion

    https://doi.org/10.1136/neurintsurg-2018-014320

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      Footnotes

      • 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.