Department of Interventional Neuroradiology, UCSF, San Francisco, California 94143, USA.
J Neurointerv Surg. 2013 Mar;5(2):128-34. doi: 10.1136/neurintsurg-2011-010100. Epub 2012 Feb 2.
The three largest adult stroke trials investigating mechanical embolectomy retrieval devices in acute stroke (the Merci, Multi Merci and Penumbra Pivotal Stroke Trials) excluded children. There is a need to expand the literature on mechanical embolectomy in large vessel pediatric arterial ischemic stroke. This paper reports the use of two mechanical embolectomy devices cleared by the Federal Drug Administration (FDA) in four consecutive cases.
Our pediatric stroke database from 2002 to the present was reviewed retrospectively. Patients were included if they were diagnosed with an acute large vessel occlusion, were <18 years of age and underwent recanalization with a device cleared by the FDA. Clinical and radiographic results were abstracted from medical record review. The Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score at presentation and at discharge and a pediatric-modified Rankin Scale (Ped-mRS) at approximately 90 days were scored retrospectively based on documented examinations.
Four patients aged 4-17 years with a PedNIHSS score at presentation ranging from 2 to 17 points underwent mechanical embolectomy for reperfusion of the basilar artery (n=3), M1 segment of the right middle cerebral artery (n=1) and right internal carotid artery terminus (n=1). Thrombolysis in cerebral infarction (TICI) grade 3 was achieved in four vessels and TICI grade 2A was achieved in one vessel; there was one asymptomatic intraparenchymal hemorrhage. Intra-arterial tissue plasminogen activator was administered in two vessels. The PedNIHSS score at discharge ranged from 0 to 16 points and the Ped-mRS score at approximately 90 days ranged from 0 to 3 with 75% achieving a Ped-mRS score of ≤2.
Mechanical embolectomy using the Merci and Penumbra systems may be a feasible therapeutic option in the treatment of large vessel pediatric arterial ischemic stroke.
三项最大的成人中风临床试验（即 Merci、Multi Merci 和 Penumbra 关键中风试验）均排除了儿童，旨在研究机械取栓装置在急性中风中的应用。因此，有必要扩大在大型儿科动脉缺血性中风中应用机械取栓的文献。本文报告了使用两种经美国食品药品监督管理局（FDA）批准的机械取栓装置在连续 4 例患者中的应用。
回顾性分析了 2002 年至今的儿科中风数据库。纳入标准为：诊断为急性大血管闭塞、年龄<18 岁、接受 FDA 批准的器械再通治疗的患者。从病历回顾中提取临床和影像学结果。根据记录的检查，回顾性地对就诊时和出院时的小儿国立卫生研究院中风量表（PedNIHSS）评分以及大约 90 天时的小儿改良 Rankin 量表（Ped-mRS）评分进行评分。
4 例年龄 4-17 岁的患者，就诊时的 PedNIHSS 评分 2-17 分，因基底动脉（n=3）、右侧大脑中动脉 M1 段（n=1）和右侧颈内动脉终末段（n=1）闭塞而行机械取栓。4 根血管达到血栓再通分级（TICI）3 级，1 根血管达到 TICI 2A 级；1 例无症状性脑实质内出血。2 根血管给予了动脉内组织型纤溶酶原激活剂。出院时的 PedNIHSS 评分 0-16 分，大约 90 天时的 Ped-mRS 评分 0-3 分，75%的患者达到了 Ped-mRS 评分≤2。
使用 Merci 和 Penumbra 系统进行机械取栓可能是治疗大型儿科动脉缺血性中风的一种可行的治疗选择。
