Mechanical thrombectomy for pediatric acute ischemic stroke: review of the literature.

ABSTRACT

OBJECTIVE: Given recent strongly positive randomized controlled adult mechanical thrombectomy trials, we sought to perform a comprehensive review of available literature on IA pediatric stroke intervention, with a focus on modern mechanical devices. METHODS: PubMed search for pediatric patients undergoing IA treatment of acute ischemic stroke (AIS) using modern devices between 2008 and 2015. 29 patients were included in this analysis. RESULTS: Average age was 10.3 years, 74.1% male, middle cerebral and basilar arteries represented 89.6% of 36 occluded vessels, and average pediatric stroke scale score of 18.1. Average time from symptom onset to intervention was 8.8 hours and 13.8% of patients received IV tissue plasminogen activator prior to mechanical thrombectomy. Stent retrievers were used in 58.6% of cases, the Penumbra system in 34.5%, and the Merci device in 27.6%. Modified Thrombolysis In Cerebral Infarction 2b/3 recanalization was achieved in 75.9% of cases. There were no major adverse events related to the intervention, although one procedure was associated with device malfunction without a definite change in long-term outcome. The average modified Rankin Scale (mRS) score was <1 (0.86) at the longest available follow-up period, based on clinical description or provided mRS score. CONCLUSIONS: This study suggests that mechanical thrombectomy in pediatric patients presenting with high pediatric NIH Stroke Scale scores and proximal large vessel occlusion is associated with high recanalization rates and excellent clinical outcome, although this is a retrospective review and the sample size is too small to make any definitive conclusions. This study provides class IVC evidence that endovascular treatment of pediatric AIS increases the chance of a good clinical outcome.