Acute ischemic stroke (AIS) in children has been difficult to diagnose, treat and study, due to atypical clinical presentation, imaging challenges and the rarity of large-vessel embolic occlusion as the etiology of acute neurological change in children. With endovascular thrombectomy showing success in randomized trials of adult AIS, the technique is increasingly being extrapolated to pediatric stroke. However, there is little evidence regarding the safety or efficacy of applying in children these devices developed and tested in adults. There is concern about a vessel-to-device size mismatch that may result in a different complication and benefit profile than typically seen. We report on the successful application in pediatric stroke of a newer-generation, smaller stent retriever, designed to be delivered through relatively smaller and more navigable microcatheters than the prior generation of this device.

Keywords:
Stent retriever device, Endovascular thrombectomy, Pediatric acute ischemic stroke
1.
Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, et al: Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol 2014;13:35-43.
2.
DeVeber GA, MacGregor D, Curtis R, Mayank S: Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 2000;15:316-324.
3.
Friedman N: Pediatric stroke: past, present and future. Adv Pediatr 2009;56:271-299.
4.
Lo W, Zamel K, Ponnappa K, Allen A, Chisolm D, Tang M, et al: The cost of pediatric stroke care and rehabilitation. Stroke 2008;39:161-165.
5.
Rafay MF, Pontigon A-M, Chiang J, Adams M, Jarvis DA, Silver F, et al: Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke 2009;40:58-64.
6.
Srinivasan J, Miller SP, Phan TG, Mackay MT: Delayed recognition of initial stroke in children: need for increased awareness. Pediatrics 2009;124:e227-e234.
7.
Hu YC, Chugh C, Jeevan D, Gillick JL, Marks S, Stiefel MF: Modern endovascular treatments of occlusive pediatric acute ischemic strokes: case series and review of the literature. Childs Nerv Syst 2014;30:937-943.
8.
Ganesan V, Prengler M, McShane MA, Wade AM, Kirkham FJ: Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol 2003;53:167-173.
9.
Amlie-Lefond C, deVeber G, Chan AK, Benedict S, Bernard T, Carpenter J, et al: Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:530-536.
10.
Amlie-Lefond C, Chan AKC, Kirton A, deVeber G, Hovinga CA, Ichord R, et al: Thrombolysis in acute childhood stroke: design and challenges of the Thrombolysis in Pediatric Stroke clinical trial. Neuroepidemiology 2009;32:279-286.
11.
Rivkin MJ, deVeber G, Ichord RN, Kirton A, Chan AK, Hovinga CA, et al: Thrombolysis in Pediatric Stroke study. Stroke 2015;46:880-885.
12.
Roach ES, Golomb MR, Adams R, Biller J, Daniels S, DeVeber G, et al: Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 2008;39:2644-2691.
13.
Huded V, Kamath V, Chauhan B, de Souza R, Nair R, Sapare A, et al: Mechanical thrombectomy using solitaire in a 6-year-old child. J Vasc Interv Neurol 2015;8:13-16.
14.
Vega RA, Chan JL, Anene-maidoh TI, Grimes MM, Reavey-Cantwell JF: Mechanical thrombectomy for pediatric stroke arising from an atrial myxoma: case report. J Neurosurg Pediatr 2015;15:301-305.
15.
Zanaty M, Chalouhi N, Starke RM, Tjoumakaris S, Hasan D, Hann S, et al: Endovascular stroke intervention in the very young. Clin Neurol Neurosurg 2014;127:15-18.
16.
Stidd DA, Lopes DK: Successful mechanical thrombectomy in a 2-year-old male through a 4-French guide catheter. Neurointervention 2014;9:94-100.
17.
Fink J, Sonnenborg L, Larsen LL, Born AP, Holtmannspötter M, Kondziella D: Basilar artery thrombosis in a child treated with intravenous tissue plasminogen activator and endovascular mechanical thrombectomy. J Child Neurol 2013;28:1521-1526.
18.
Ellis MJ, Amlie-Lefond C, Orbach DB: Endovascular therapy in children with acute ischemic stroke: review and recommendations. Neurology 2012;79:158-164.
19.
Savastano L, Gemmete JJ, Pandey AS, Roark C, Chaudhary N: Acute ischemic stroke in a child due to basilar artery occlusion treated successfully with a stent retriever. BMJ Case Rep 2015;bcr2015011821.
20.
Mittal SO, ThatiGanganna S, Kuhns B, Strbian D, Sundararajan S: Acute ischemic stroke in pediatric patients. Stroke 2015;46:e32-e34.
21.
Sainz de la Maza S, Felipe AD, Matute MC, Fandino E, Mendez JC, Morillo P, et al: Acute ischemic stroke in a 12-year-old successfully treated with mechanical thrombectomy. J Child Neurol 2013;29:269-273.
22.
Felker MV, Zimmer JA, Golomb MR: Failure of a clot retrieval device in an adolescent stroke patient. Pediatr Neurol 2010;43:435-438.
© 2016 S. Karger AG, Basel
2016
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