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A big problem in a small patient
  1. Lucas Elijovich
  1. Correspondence to Dr Lucas Elijovich, Semmes-Murphey Clinic, Memphis, Tennessee 38120, USA; lelijovich{at}

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The pages of JNIS are populated with an ever-increasing number of papers on acute ischemic stroke emergent large vessel occlusion (ELVO) thrombectomy.1 We know thrombectomy is extremely effective and, as such, clinical practice has evolved to the point that we are able to explore the outer edges of its limits. Reports on thrombectomy in nonagenarians and distal occlusions are two examples of the type of work that is the byproduct of the pivotal thrombectomy clinical trials.2 3

Looking back a decade ago and considering the time consuming and often fruitless thrombectomies I performed with first-generation devices, I certainly did not foresee our current reality. Cases now routinely last only 15 min from groin puncture to complete revascularization and 2-day hospitalizations for large vessel occlusion strokes are not uncommon.

So, what is the next step? Should we further focus our attention in the direction of 100-year-olds and M4 occlusions? I would quote Jerry Seinfeld and respond with a similar lack of enthusiasm, ‘Not that there is anything wrong with that …’, and simultaneously urge our field to begin to look in the opposite direction. There is a strong argument to increase our attention to the youngest stroke patients.

Pediatric stroke is not a small problem but the complexities of pediatric research, …

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  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent for publication Not required.