Stowe Robert Clinton, Kan Peter, Breen Day Burruss, Agarwal Sonika
Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, United States.
Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States.
Brain Dev. 2018 Jan;40(1):81-84. doi: 10.1016/j.braindev.2017.08.001. Epub 2017 Aug 24.
Certain pediatric populations have increased risk of ischemic strokes, including those with cardiac disease and those dependent on mechanical circulatory devices such as ventricular assist devices. Due to their need for chronic anticoagulation, patients with mechanical circulatory devices are not candidates for systemic thrombolysis and thus treatment of acute ischemic stroke is limited.
A 9-year-old boy with a ventricular assist device presented with acute onset of dense right hemiparesis, global aphasia, and a pediatric NIHSS score of 23. Vessel imaging showed an occlusive proximal left middle cerebral artery thrombus successfully removed via mechanical thrombectomy within 4.5h of symptom onset. His pediatric NIHSS 72h after presentation was 3.
This case represents only the third report of successful mechanical thrombectomy for acute ischemic stroke in a pediatric patient with a ventricular assist device and the first using the Trevo stent retriever system. Our patient's excellent outcome highlights mechanical thrombectomy as a potential therapeutic option for children with ventricular assist devices experiencing acute neurological changes and radiologic evidence of proximal vessel occlusion.
某些儿科人群发生缺血性中风的风险增加，包括患有心脏病的儿童以及依赖机械循环装置（如心室辅助装置）的儿童。由于需要长期抗凝，使用机械循环装置的患者不适合进行全身溶栓治疗，因此急性缺血性中风的治疗受到限制。
一名9岁男孩使用心室辅助装置，出现急性起病的严重右侧偏瘫、完全性失语，小儿国立卫生研究院卒中量表（NIHSS）评分为23分。血管成像显示左侧大脑中动脉近端有闭塞性血栓，在症状发作后4.5小时内通过机械取栓成功清除。他就诊72小时后的小儿NIHSS评分为3分。
本病例是关于使用心室辅助装置的儿科患者急性缺血性中风成功进行机械取栓的第三例报告，也是首例使用Trevo支架取栓系统的报告。我们患者的良好预后凸显了机械取栓作为心室辅助装置儿童出现急性神经功能改变且有近端血管闭塞影像学证据时的一种潜在治疗选择。
