Mechanical Thrombectomy in Children and Adolescents: Report of Five Cases and Literature Review

Overview

Journal Stroke Vasc Neurol

Specialty Cardiology & Vascular Diseases

Date 2019 Jan 15

PMID 30637131

Citations 8

Authors

Pervinder Bhogal

Victoria Hellstern

Muhammad AlMatter

Oliver Ganslandt

Hansjorg Bazner

Marta Aguilar Perez

Hans Henkes

Affiliations

Soon will be listed here.

Abstract

Background: Paediatric arterial ischaemic stroke is an important cause of morbidity and mortality among children. Currently, there are no recommendations regarding mechanical thrombectomy in children despite overwhelming evidence of improved outcomes in adults. Therefore, the need for individual case reports and case series is important to highlight potential advantages and disadvantages in this approach.

Case Descriptions: We retrospectively searched our prospectively maintained database of patients undergoing mechanical thrombectomy for ischaemic stroke. We describe five children, aged between 7 and 17, who underwent mechanical thrombectomy for acute ischaemic stroke. We provide an account of their clinical presentations, operative treatment and postoperative outcome.

Discussion: Mechanical thrombectomy in children, especially older children, can be performed safely and with existing devices. Although a randomised controlled trial would provide compelling evidence of the potential advantages to this technique, the lack of this should not prevent the use of this procedure by trained neurointerventionists.

Citing Articles

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Mechanical Thrombectomy for Pediatric Large Vessel Occlusions : A Systematic Review and Meta-analysis.

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References

Kirkham F, Prengler M, Hewes D, Ganesan V . Risk factors for arterial ischemic stroke in children. J Child Neurol. 2000; 15(5):299-307. DOI: 10.1177/088307380001500506. View

DeVeber G, MacGregor D, Curtis R, Mayank S . Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol. 2000; 15(5):316-24. DOI: 10.1177/088307380001500508. View

Alberts M, Hademenos G, Latchaw R, Jagoda A, Marler J, Mayberg M . Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA. 2000; 283(23):3102-9. DOI: 10.1001/jama.283.23.3102. View

Adams R, Acker J, Alberts M, Andrews L, Atkinson R, Fenelon K . Recommendations for improving the quality of care through stroke centers and systems: an examination of stroke center identification options: multidisciplinary consensus recommendations from the Advisory Working Group on Stroke Center Identification.... Stroke. 2002; 33(1):e1-7. View

Monagle P, Chan A, Albisetti M, Vegh P, Andrew M, Mitchell L . Fibrinolytic system in adolescents: response to venous occlusion stress tests. Pediatr Res. 2003; 53(2):333-7. DOI: 10.1203/01.PDR.0000047644.97422.F2. View

Ganesan V, Prengler M, McShane M, Wade A, Kirkham F . Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol. 2003; 53(2):167-73. DOI: 10.1002/ana.10423. View

Strolin Benedetti M, Baltes E . Drug metabolism and disposition in children. Fundam Clin Pharmacol. 2003; 17(3):281-99. DOI: 10.1046/j.1472-8206.2003.00140.x. View

Fullerton H, Wu Y, Zhao S, Johnston S . Risk of stroke in children: ethnic and gender disparities. Neurology. 2003; 61(2):189-94. DOI: 10.1212/01.wnl.0000078894.79866.95. View

Waitzman A, Posnick J, Armstrong D, Pron G . Craniofacial skeletal measurements based on computed tomography: Part II. Normal values and growth trends. Cleft Palate Craniofac J. 1992; 29(2):118-28. DOI: 10.1597/1545-1569_1992_029_0118_csmboc_2.3.co_2. View

10.

Monagle P, Barnes C, Ignjatovic V, Furmedge J, Newall F, Chan A . Developmental haemostasis. Impact for clinical haemostasis laboratories. Thromb Haemost. 2006; 95(2):362-72. DOI: 10.1160/TH05-01-0047. View

11.

Ganesan V, Prengler M, Wade A, Kirkham F . Clinical and radiological recurrence after childhood arterial ischemic stroke. Circulation. 2006; 114(20):2170-7. DOI: 10.1161/CIRCULATIONAHA.105.583690. View

12.

Maguire J, deVeber G, Parkin P . Association between iron-deficiency anemia and stroke in young children. Pediatrics. 2007; 120(5):1053-7. DOI: 10.1542/peds.2007-0502. View

13.

McGlennan C, Ganesan V . Delays in investigation and management of acute arterial ischaemic stroke in children. Dev Med Child Neurol. 2008; 50(7):537-40. DOI: 10.1111/j.1469-8749.2008.03012.x. View

14.

Rafay M, Pontigon A, Chiang J, Adams M, Jarvis D, Silver F . Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke. 2008; 40(1):58-64. DOI: 10.1161/STROKEAHA.108.519066. View

15.

Srinivasan J, Miller S, Phan T, MacKay M . Delayed recognition of initial stroke in children: need for increased awareness. Pediatrics. 2009; 124(2):e227-34. DOI: 10.1542/peds.2008-3544. View

16.

Goldenberg N, Bernard T, Fullerton H, Gordon A, deVeber G . Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol. 2009; 8(12):1120-7. DOI: 10.1016/S1474-4422(09)70241-8. View

17.

Mallick A, OCallaghan F . The epidemiology of childhood stroke. Eur J Paediatr Neurol. 2009; 14(3):197-205. DOI: 10.1016/j.ejpn.2009.09.006. View

18.

Cnossen M, Aarsen F, Akker S, Danen R, Appel I, Steyerberg E . Paediatric arterial ischaemic stroke: functional outcome and risk factors. Dev Med Child Neurol. 2010; 52(4):394-9. DOI: 10.1111/j.1469-8749.2009.03580.x. View

19.

Grunwald I, Walter S, Shamdeen M, Dautermann A, Roth C, Haass A . New mechanical recanalization devices - the future in pediatric stroke treatment?. J Invasive Cardiol. 2010; 22(2):63-6. View

20.

MacKay M, Wiznitzer M, Benedict S, Lee K, deVeber G, Ganesan V . Arterial ischemic stroke risk factors: the International Pediatric Stroke Study. Ann Neurol. 2011; 69(1):130-40. DOI: 10.1002/ana.22224. View