Khameneh Bagheri Arash, Khalili Mitra, Alavi Samin, Khaffafpour Zahra, Aghapour Mehdi, Zamani Alireza, Mirmoghaddam Paniz
Department of Radiology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Radiology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ann Med Surg (Lond). 2024 Oct 21;86(12):7402-7407. doi: 10.1097/MS9.0000000000002680. eCollection 2024 Dec.
Arterial ischemic stroke (AIS) caused by occlusion of large vessels in childhood is a devastating rare condition that can contribute to long-term disabilities. Childhood leukemia is identified as a recognized risk factor for ischemic strokes. Mechanical thrombectomy is the standard of care for large vessel occlusions in adults. However, there are still no definite recommendations regarding the application and outcomes of endovascular thrombectomy and the devices used for pediatric patients with arterial ischemic stroke.
The authors report a 13-year-old female with acute lymphoblastic leukemia who developed AIS due to thrombosis in the left internal carotid and proximal middle cerebral artery in the induction phase of treatment. The patient underwent successful mechanical thrombectomy via Solumbra by using "Embolus Retriever with Interlinked Cages (ERIC)" stent retriever and Sofia plus catheter, which resulted in successful recanalization of ICA and MCA.
Selected pediatric patients with AIS due to large vessel occlusions can benefit from mechanical thrombectomy. Although the recently published literature demonstrated the efficacy and safety of MT in children, strong guideline recommendations are still absent. At present, the last AHA/ASA guidelines for early management of AIS recommends intravenous thrombolysis and endovascular therapy in adults, whereas controversy still exists in children. An urgent approach within the defined therapeutic time frame and a multidisciplinary team specialized in pediatric stroke with professionally trained interventional neuroradiologist is essential for achieving optimal results.
Mechanical thrombectomy provides promising results with high rates of arterial recanalization and favorable outcomes in pediatric patients with AIS.
儿童期因大血管闭塞导致的动脉缺血性卒中（AIS）是一种罕见的严重疾病，可导致长期残疾。儿童白血病被认为是缺血性卒中的一个公认危险因素。机械取栓术是成人治疗大血管闭塞的标准治疗方法。然而，对于小儿动脉缺血性卒中患者，关于血管内取栓术的应用、结果以及所使用的设备，目前仍没有明确的建议。
作者报告了一名13岁患急性淋巴细胞白血病的女性，在治疗诱导期因左颈内动脉和大脑中动脉近端血栓形成而发生AIS。患者通过使用“带互连网篮的栓子回收器（ERIC）”支架取栓器和Sofia plus导管，经Solumbra技术成功进行了机械取栓，实现了颈内动脉（ICA）和大脑中动脉（MCA）的成功再通。
部分因大血管闭塞导致AIS的小儿患者可从机械取栓术中获益。尽管最近发表的文献证明了机械取栓术在儿童中的有效性和安全性，但仍然缺乏强有力的指南推荐。目前，美国心脏协会/美国卒中协会（AHA/ASA）最新的AIS早期管理指南推荐成人进行静脉溶栓和血管内治疗，而儿童患者仍存在争议。在规定的治疗时间范围内采取紧急措施，以及由专业训练的介入神经放射科医生组成的小儿卒中多学科团队，对于取得最佳治疗效果至关重要。
机械取栓术在小儿AIS患者中取得了有前景的结果，动脉再通率高且预后良好。
