Buompadre Maria Celeste, Andres Kathleen, Slater Lee-Anne, Mohseni-Bod Hadi, Guerguerian Anne-Marie, Branson Helen, Laughlin Suzanne, Armstrong Derek, Moharir Mahendranath, deVeber Gabrielle, Humpl Tilman, Honjo Osami, Keshavjee Shaf, Ichord Rebecca, Pereira Vitor, Dlamini Nomazulu
Division of Neurology, Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Medical Imaging, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Surgery, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
Pediatr Neurol. 2017 Jan;66:21-27. doi: 10.1016/j.pediatrneurol.2016.09.007. Epub 2016 Sep 14.
The updated American Heart Association/American Stroke Association guidelines include recommendation for thrombectomy in certain adult stroke cases. The safety and efficacy of thrombectomy in children are unknown. An 8-year-old girl experienced acute stroke symptoms on two occasions while therapeutically anticoagulated on Novalung. Computed tomography scans showed proximal vessel thrombi, which were retrieved using a Trevo device without hemorrhagic complications. Postprocedural assessment found respective decreases in the National Institutes of Health Stroke Scale score from 10 to 4 and 12 to 7. The indications for treatment and early benefits observed in our case are consistent with other pediatric thrombectomy cases reported. However, publication bias and the heterogeneity of reported cases prevent drawing conclusions about the safety and efficacy of thrombectomy in children. Anticipating that updates to adult stroke guidelines would likely incite stroke providers to consider thrombectomy in children, our institution developed guidelines for thrombectomy before the index patient. Establishing institutional guidelines before considering thrombectomy in children may optimize patient safety.
美国心脏协会/美国中风协会的最新指南包括在某些成人中风病例中进行血栓切除术的建议。血栓切除术在儿童中的安全性和有效性尚不清楚。一名8岁女孩在使用诺瓦心肺机进行治疗性抗凝期间两次出现急性中风症状。计算机断层扫描显示近端血管血栓，使用Trevo装置将其取出，未出现出血并发症。术后评估发现美国国立卫生研究院中风量表评分分别从10分降至4分和从12分降至7分。我们病例中观察到的治疗指征和早期获益与其他报道的儿科血栓切除术病例一致。然而，发表偏倚和报道病例的异质性阻碍了就血栓切除术在儿童中的安全性和有效性得出结论。预计成人中风指南的更新可能会促使中风治疗人员考虑对儿童进行血栓切除术，我们机构在首例患者之前就制定了血栓切除术指南。在考虑对儿童进行血栓切除术之前制定机构指南可能会优化患者安全。
