He Lucy, Ladner Travis R, Pruthi Sumit, Day Matthew A, Desai Aditi A, Jordan Lori C, Froehler Michael T
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA Cerebrovascular Program, Departments of Neurology and Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA Vanderbilt School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Neurointerv Surg. 2016 Oct;8(10):1067-71. doi: 10.1136/neurintsurg-2015-012034. Epub 2015 Nov 6.
The safety of using adult-sized neuroendovascular devices in the smaller pediatric vasculature is not known. In this study we measure vessel diameters in the cervical and cranial circulation in children to characterize when adult-approved devices might be compatible in children.
For 54 children without vasculopathy (mean age 9.5±4.9 years (range 0.02-17.8), 20F/34M) undergoing catheter angiography, the diameters of the large vessels in the cervical and cranial circulation (10 locations, 611 total measurements) were assessed by three radiologists. Mean±SD diameter was calculated for the following age groups: 0-6 months, 1, 2, 3, 4, 5-9, 10-14, and 15-18 years. To compare with adult sizes, each vessel measurement was normalized to the respective region mean diameter in the oldest age group (15-18 years). Normalized measurements were compared with age and fitted to a segmented regression.
Vessel diameters increased rapidly from 0 to 5 years of age (slope=0.069/year) but changed minimally beyond that (slope=0.005/year) (R(2)=0.2). The regression model calculated that, at 5 years of age, vessels would be 94% of the diameter of the oldest age group (compared with 59% at birth). In addition, most vessels in children under 5, while smaller, were still potentially large enough to be compatible with many adult devices.
The growth curve of the cervicocerebral vasculature displays rapid growth until age 5, at which point most children's vessels are nearly adult size. By age 5, most neuroendovascular devices are size-compatible, including thrombectomy devices for stroke. Under 5 years of age, some devices might still be compatible.
在较小的儿科血管系统中使用成人体积的神经血管介入器械的安全性尚不清楚。在本研究中，我们测量儿童颈部和颅内循环血管的直径，以确定何时成人批准使用的器械可能适用于儿童。
对54例无血管病变的儿童（平均年龄9.5±4.9岁（范围0.02 - 17.8岁），20例女性/34例男性）进行导管血管造影，由三位放射科医生评估颈部和颅内循环大血管的直径（10个部位，共611次测量）。计算以下年龄组的平均直径±标准差：0 - 6个月、1岁、2岁、3岁、4岁、5 - 9岁、10 - 14岁和15 - 18岁。为了与成人尺寸进行比较，将每个血管测量值相对于最年长年龄组（15 - 18岁）相应区域的平均直径进行归一化。将归一化测量值与年龄进行比较，并拟合分段回归。
血管直径在0至5岁时迅速增加（斜率 = 0.069/年），但此后变化极小（斜率 = 0.005/年）（R² = 0.2）。回归模型计算得出，5岁时血管直径将达到最年长年龄组直径的94%（出生时为59%）。此外，5岁以下儿童的大多数血管虽然较小，但仍可能足够大以适配许多成人器械。
颈脑血管系统的生长曲线在5岁前显示快速生长，此时大多数儿童血管接近成人尺寸。到5岁时，大多数神经血管介入器械在尺寸上是适配的，包括用于中风的取栓器械。5岁以下时，一些器械可能仍然适配。
