Thrombectomy for acute stroke in childhood: a case report, literature review, and recommendations

Abstract AHA/ASA updated guidelines include recommendation for thrombectomy in certain adult stroke cases. The safety and efficacy of thrombectomy in children is unknown. An 8-year-old girl experienced acute stroke symptoms on two occasions while therapeutically anticoagulated on NovalungR . CTs sho...

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Published in:Pediatric neurology 2017-01, Vol.66, p.21-27
Main Authors: Buompadre, Maria Celeste, MD, Andres, Kathleen, MN, NP-Paediatrics, Slater, Lee-Anne, MD, Mohseni-Bod, Hadi, MD, FMGEMS, USML, MRCPCH, Guerguerian, Anne-Marie, MD, FAAP, FRCPC, Branson, Helen, BSc, MBBS, FRANZCR, Laughlin, Suzanne, MD, FRCP(C), Armstrong, Derek, MB, BS, FRCP (C), Moharir, Mahendranath, MD, deVeber, Gabrielle, MD, Humpl, Tilman, MD, PhD, Honjo, Osami, MD PhD, Keshavjee, Shaf, MD, MSc, FRCSC, FACS, Ichord, Rebecca, MD, Pereira, Vitor, MD, MSc, Dlamini, Nomazulu, MD
Format: Article
Language:English
Subjects:
Brain Ischemia - diagnostic imaging
Brain Ischemia - surgery
Cerebral Arterial Diseases - diagnostic imaging
Cerebral Arterial Diseases - surgery
Child
embolectomy
endovascular procedures
Female
Humans
interventional lung-assist device
mechanical thrombectomy
Neurology
oxygenators
pediatric stroke
Pediatrics
Practice Guidelines as Topic
stroke
Stroke - diagnostic imaging
Stroke - surgery
Thrombectomy
treatment
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Summary:Abstract AHA/ASA updated guidelines include recommendation for thrombectomy in certain adult stroke cases. The safety and efficacy of thrombectomy in children is unknown. An 8-year-old girl experienced acute stroke symptoms on two occasions while therapeutically anticoagulated on NovalungR . CTs showed proximal vessel thrombi, which were retrieved using a Trevo device without hemorrhagic complications. Post-procedural assessment found respective decreases in the NIHSS score from 10 to 4 and 12 to 7. The indications for treatment and early benefits observed in our case are consistent with other paediatric thrombectomy cases reported. However, publication bias and the heterogeneity of reported cases prevents drawing conclusions about the safety and efficacy of thrombectomy in children. Anticipating that updates to adult stroke guidelines would likely incite stroke providers to consider thrombectomy in children, our institution developed consensus-based guidelines for thrombectomy prior to the index. Establishing institutional guidelines before considering thrombectomy in children may optimize patient safety.
ISSN:0887-8994
1873-5150
DOI:10.1016/j.pediatrneurol.2016.09.007