Cao J J, Di Q, Shen G, Li S L, Chen C H, Xiong Y, Jiao Y H, Guo X F
Department of Intervention & Hemangioma, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China.
Zhonghua Er Ke Za Zhi. 2023 Feb 2;61(2):159-163. doi: 10.3760/cma.j.cn112140-20220927-00844.
To assess the feasibility of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) in children. Clinical data and follow-up information of 4 AIS children who received EVT in the Department of Intervention & Hemangioma at the Children's Hospital of the Capital Institute of Pediatrics from December 2020 to June 2021 were collected retrospectively. The vascular recanalization after EVT was assessed by the modified thrombolysis in cerebral infarction (mTICI) score. Efficacy outcomes were assessed with initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and the modified Rankin scale (mRS) score at 3 and 6 months after treatment. Safety assessments included perioperative complications and intracranial hemorrhage post-treatment. A total of 5 EVT treatment were performed on 4 children with AIS, of whom 3 were male. The age of onset was 4.6, 13.8, 7.8, 8.0, 8.9 years, respectively. The time from symptom onset to initiation of EVT was 19.0, 25.0, 22.0, 4.0, 16.5 hours, respectively and all patients achieved successful recanalization of the vessel after EVT (mTICI≥2b). The PedNIHSS score was 39, 14, 25, 39, 24 before treatment and decreased to 8, 1, 12, 39, 5 at discharge. All the procedures were performed with no perioperative complications. Only 1 patient with congenital heart disease had a recurrent AIS with malignant brain oedema and brain hernia. Although the occluded vessels were successfully recanalized,the symptoms were not improved and this patient died after treatment abandonment. The other 3 patients achieved good recovery at 6 months postoperatively. The mRS score of 3 patients was 3, 1, 2 at 3 months after EVT and decreased to 2, 1, 1 at 6 months. EVT treatment may be feasible and safe for pediatric AIS due to large vessel occlusion even when the treatment was initiated 6 hours post stroke, but children with heart disease may have a dismal prognosis.
评估血管内血栓切除术（EVT）治疗儿童急性缺血性卒中（AIS）的可行性。回顾性收集2020年12月至2021年6月在首都儿科研究所附属儿童医院介入与血管瘤科接受EVT治疗的4例AIS儿童的临床资料和随访信息。通过改良脑梗死溶栓（mTICI）评分评估EVT后的血管再通情况。疗效结果通过治疗前及治疗后的儿童国立卫生研究院卒中量表（PedNIHSS）评分以及治疗后3个月和6个月的改良Rankin量表（mRS）评分进行评估。安全性评估包括围手术期并发症和治疗后颅内出血。共对4例AIS儿童进行了5次EVT治疗，其中3例为男性。发病年龄分别为4.6岁、13.8岁、7.8岁、8.0岁、8.9岁。从症状发作到开始EVT的时间分别为19.0小时、25.0小时、22.0小时、4.0小时、16.5小时，所有患者在EVT后均实现了血管成功再通（mTICI≥2b）。治疗前PedNIHSS评分为39分、14分、25分、39分、24分，出院时降至8分、1分、12分、39分、5分。所有手术均无围手术期并发症。仅1例先天性心脏病患者复发AIS并伴有恶性脑水肿和脑疝。尽管闭塞血管成功再通，但症状未改善，该患者在放弃治疗后死亡。其他3例患者术后6个月恢复良好。3例患者在EVT后3个月的mRS评分为3分、1分、2分，6个月时降至2分、1分、1分。对于因大血管闭塞导致的儿童AIS，即使在卒中后6小时开始治疗，EVT治疗可能也是可行且安全的，但患有心脏病的儿童预后可能较差。
