Balcı Sinan, Eroğlu-Ertuğrul Nesibe Gevher, Birbilen Ahmet Ziya, Yalnızoğlu Dilek, Kesici Selman, Karagöz Tevfik, Arat Anıl
Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye.
Hacettepe University Faculty of Medicine, Department of Child Health and Diseases, Division of Pediatric Neurology, Ankara, Türkiye.
Diagn Interv Radiol. 2025 Apr 28;31(3):237-248. doi: 10.4274/dir.2024.242675. Epub 2024 May 30.
Unlike in adults, the indications and techniques for mechanical thrombectomy for arterial ischemic stroke (AIS) in children are not clearly established. The medical and interventional management of children with acute large vessel occlusion may entail the modification of the standardized management of this condition in adults. We present six cases of children who underwent non-routine thrombectomy for AIS.
We retrospectively reviewed the records of children diagnosed with AIS between 2015 and 2023 and evaluated patient characteristics, procedural technical data, and final clinical outcomes. Procedures deviating from the current definition and indications for AIS treatment in adults as well as previously reported pediatric thrombectomy cases were defined as non-routine thrombectomy.
Seven non-routine thrombectomy procedures in six children were included in the study. The National Institutes of Health Stroke Scale scores on admission ranged from 4 to 35; no procedure-related mortality or major neurologic morbidity occurred. One child died of causes related to the initial severe heart failure and stroke; otherwise, all the children had a modified Rankin scale score of 0 to 1 at follow-up. Unique clinical and procedural features in our case series included presentation with acute stent occlusion (two children), bilateral simultaneous internal carotid artery occlusions associated with a unilateral tandem middle cerebral artery (MCA) occlusion (one child), MCA occlusion caused by thromboembolism of the atrial myxoma (one child), and very distal (one child) or delayed thrombectomy (two children).
Modifications to the standard medical and interventional algorithms may be required for mechanical thrombectomy in children.
Referral centers specialized in pediatric neurology, pediatric anesthesia, and pediatric intervention are optimal for treating children using mechanical thrombectomy and for modifying the treatment, if required.
与成人不同，儿童动脉缺血性卒中（AIS）机械取栓的适应证和技术尚未明确确立。急性大血管闭塞儿童的药物和介入治疗可能需要对成人这种疾病的标准化治疗进行调整。我们报告6例接受非常规AIS取栓术的儿童病例。
我们回顾性分析了2015年至2023年期间诊断为AIS的儿童病例记录，并评估了患者特征、手术技术数据和最终临床结局。偏离当前成人AIS治疗定义和适应证以及先前报道的儿科取栓病例的手术被定义为非常规取栓术。
本研究纳入了6例儿童的7例非常规取栓手术。入院时美国国立卫生研究院卒中量表评分范围为4至35分；未发生与手术相关的死亡或严重神经功能障碍。1例儿童死于与初始严重心力衰竭和卒中相关的原因；否则，所有儿童在随访时改良Rankin量表评分为0至1分。我们病例系列中的独特临床和手术特征包括急性支架闭塞（2例儿童）、双侧同时性颈内动脉闭塞合并单侧串联大脑中动脉（MCA）闭塞（1例儿童）、心房黏液瘤血栓栓塞导致的MCA闭塞（1例儿童）以及非常远端的（1例儿童）或延迟取栓（2例儿童）。
儿童机械取栓可能需要对标准药物和介入治疗方案进行调整。
专门从事儿科神经学、儿科麻醉和儿科介入治疗的转诊中心最适合使用机械取栓治疗儿童，并在需要时调整治疗方案。
