Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Neurology, Children's National Hospital, Washington, District of Columbia, USA.
J Neurointerv Surg. 2021 Sep;13(9):794-798. doi: 10.1136/neurintsurg-2021-017311. Epub 2021 Apr 8.
Endovascular therapies for acute childhood stroke remain controversial and little evidence exists to determine the minimum age and size cut-off for thrombectomy in children. Despite this, an increasing number of reports suggest feasibility of thrombectomy in at least some children by experienced operators. When compared with adults, technical modifications may be necessary in children owing to differences in vessel sizes, tolerance of blood loss, safety of contrast and radiation exposure, and differing stroke etiologies. We review critical considerations for neurologists and neurointerventionalists when treating pediatric stroke with endovascular therapies. We discuss technical factors that may limit feasibility of endovascular therapy, including size of the femoral and cervicocerebral arteries, which contributes to vasospasm risk. The risk of femoral vasospasm can be assessed by comparing catheter outer diameter with estimated femoral artery size, which can be estimated based on the child's height. We review evidence supporting specific strategies to mitigate cervicocerebral arterial injury, including technique (stent retrieval vs direct aspiration) and device size selection. The importance of and strategies for minimizing blood loss, radiation exposure, and contrast administration are reviewed. Attention to these technical limitations is critical to delivering the safest possible care when thrombectomy is being considered for children with acute stroke.
儿童急性脑卒中的血管内治疗仍然存在争议，几乎没有证据可以确定儿童取栓术的最小年龄和大小截止值。尽管如此，越来越多的报告表明，经验丰富的术者至少可以在某些儿童中进行取栓术。与成人相比，由于血管大小、失血耐受性、对比剂和辐射暴露的安全性以及不同的脑卒中病因的差异，儿童可能需要进行技术修改。我们回顾了神经科医生和神经介入医生在使用血管内治疗治疗儿童脑卒中时需要考虑的关键因素。我们讨论了可能限制血管内治疗可行性的技术因素，包括股动脉和颈内动脉的大小，这会增加血管痉挛的风险。股动脉血管痉挛的风险可以通过比较导管外径与估计的股动脉大小来评估，股动脉大小可以根据儿童的身高来估计。我们回顾了支持特定策略减轻颈内动脉损伤的证据，包括技术（支架取出与直接抽吸）和器械大小选择。还讨论了减少失血、辐射暴露和对比剂使用的重要性和策略。在考虑对急性脑卒中的儿童进行取栓术时，注意这些技术限制对于提供尽可能安全的护理至关重要。
