Primary mechanical thrombectomy for anterior circulation stroke in children: Report of two cases and literature review

• Published in: International journal of surgery case reports Vol. 89; p. 106655
• Main Authors: Christi, Ayu Yoniko, Suroto, Nur Setiawan, Bajamal, Zaky, Al Fauzi, Asra
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-12-2021; Elsevier
• Subjects: Case Report; Endovascular treatment; Large vessel occlusion; Pediatric stroke; Primary thrombectomy; Thrombectomy; Primary thrombectomy; Thrombectomy; Case report; Endovascular treatment; Pediatric stroke; Large vessel occlusion
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.106655

Pediatric acute ischemic stroke is a rare but devastating condition with substantial rates of morbidity and mortality. Endovascular treatment is standard acute revascularization therapy for stroke in adults, but it is not well-studied in pediatrics. We report the successful treatment of two pediatric cases of anterior circulation stroke with primary mechanical thrombectomy.
Two Asian children, aged 13 and 8 years, presented to Dr. Soetomo General Academic Hospital in September 2020 and April 2021, respectively, with hemiplegia and significant Pediatric National Institutes of Health Stroke Scale (Ped NIHSS) scores. Head CT scans demonstrated hyperdense middle cerebral artery signs, suggesting large-vessel occlusion stroke. Both patients underwent emergent thrombectomy within 5 and 10 h after initial onset, and successful recanalization was achieved within an hour. Both demonstrated good neurological recovery and there was no recurrent stroke during follow-up.
Thrombectomy has appeal for childhood acute ischemic stroke (AIS) due to a longer post-stroke time window for intervention. As the short-term outcome, a significantly reduced Ped NIHSS score is achieved. Long-term outcomes are measured by modified Rankin Scale (mRS) scores. A literature review from 2016 to 2021 yielded 21 pediatric case reports of primary mechanical thrombectomy for anterior circulation stroke (including the present cases). We compare our cases with the published literature to discuss the short-term and long-term outcomes.
Mechanical thrombectomy holds promise as a treatment modality in pediatric AIS. These case reports described successful primary mechanical thrombectomy for AIS treatment in children.
•Acute ischemic stroke (AIS) with Large vessel occlusion (LVO) in children are rare but carries serious life-threatening complications.•The etiologies of acute ischemic stroke in children differ significantly from stroke in adult.•Endovascular treatment for childhood stroke has a longer time window period for intervention.•The outcome of childhood stroke that was treated with primary thrombectomy was remarkable.