Endovascular Therapies for Acute Ischemic Stroke in Children
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Acute ischemic stroke (AIS) in the pediatric population occurs in 2.3 of 100 000 children.1,2 With a mortality of 3% to 6% and morbidity up to 70%, patients with pediatric AIS experience recurrent strokes, life-long deficits, and decreased quality of life.3,4 The outcome of pediatric AIS is worsened by delayed diagnosis and lack of treatment protocols.5 Children are often brought in early after symptom onset (on average 1.7 hours after onset). There is a 12.7-hour median time to diagnosis, with >50% of diagnoses made >24 hours after arrival.6–9 Common differentials include epilepsy, complex migraines, inflammatory disease, intracranial infection, and intracranial tumors.
In adult AIS, there is overwhelming evidence to support intravenous (IV) tissue-type plasminogen activator (tPA) within 4.5 hours of symptom onset and mechanical thrombectomy for large vessel occlusions within 6 hours of symptom onset.10–15 With the delay in diagnosis and lack of treatment protocols in the pediatric population, the efficacy and safety of these treatment strategies are unknown in this population. To date, there are no prospective trials on endovascular treatment in children. However, multiple case reports have demonstrated promising results. We performed here a retrospective case review of endovascular management of pediatric AIS, with a focus on efficacy and safety.
We performed a PubMed search of all pediatric AIS cases managed with endovascular treatment from January 1990 through October 2016 using the following medical subject headings (MESH) keywords: child, pediatric, stroke, thrombolysis, endovascular, thrombectomy, tissue plasminogen activator, and case report. We also searched the relevant articles in the bibliographies. All English written articles with reports of patients <18 years who received intra-arterial (IA) fibrinolysis and IA mechanical thrombectomy with or without IV or IA fibrinolysis were included. Articles written in a language other than English or …