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  • Low-profile mechanical thrombectomy devices for large vessel occlusion in pediatric ischemic stroke

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New devices and techniques
Case series
Low-profile mechanical thrombectomy devices for large vessel occlusion in pediatric ischemic stroke
  1. Soliman Oushy1,2,
  2. Andrew Garton3,
  3. Darren B Orbach4,
  4. Alfred Pokmeng See1
    1. 1Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
    2. 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
    3. 3Neurosurgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
    4. 4Department of Neurointerventional Radiology, Harvard Medical School, Boston, Massachusetts, USA
    1. Correspondence to Dr Alfred Pokmeng See, Department of Neurosurgery, Harvard Medical School, Boston, USA; pokmeng.see{at}childrens.harvard.edu

    Abstract

    Background Mechanical thrombectomy (MT) is a well-established treatment modality for large vessel occlusion (LVO) in adults, but there are limited data in the pediatric population. The rarity of the condition makes prospective trial design difficult, and therefore evaluation of MT devices and outcomes is sparse. In pediatric LVO cases, some newer devices may be appropriate for use in revascularization procedures. Furthermore, illustrative specific device-access combinations have rarely been presented in young patients under the age of 5 years.

    Methods This was a single institution experience in intracranial MT procedures for pediatric acute ischemic stroke (AIS). A given procedure was included if there was an attempt at MT between 2015 and 2023.

    Results Sixteen endovascular procedures were performed in 15 patients with AIS, with a mean age of 7.4 years; eight patients were <5 years of age. MT was attempted in 15/16 (93.7%) procedures, including 11 (73.3%) in the anterior circulation and four (26.7%) in the posterior circulation; one case recanalized after medical treatment. The most common MT techniques were combined aspiration with a stentriever (n=10, 66.7%) and aspiration alone (n=3, 20%). Traditional stentrievers (4–6 mm) were used in seven cases and low-profile stentrievers in four cases. Improved reperfusion was achieved in all low-profile stentriever cases. Reperfusion of modified Thrombolysis in Cerebral Infaction ≥2b was obtained in 73.3% of cases, including 72.7% of those in which a stentriever was used.

    Conclusions Low-profile thrombectomy devices may achieve similar revascularization results to other approaches in challenging clinical scenarios observed in younger children.

    • Stroke
    • Thrombectomy
    • Pediatrics
    • Technique
    • Device

    https://doi.org/10.1136/jnis-2024-021574

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      Footnotes

      • Contributors Study conception and design: APS. Data collection: AG, SO. Analysis and interpretation of results: AG, SO, APS, DBO. Draft manuscript preparation: AG, SO. All authors reviewed the results and approved the final version of the manuscript. SO and AG contributed equally to this work and share first authorship.

      • 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.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.