Rajbhandari Saujanya, Breiding Philipe, Sanchez-Albisua Iciar, Brechbühl Daniel, Cornaz Buros Sandrine, Oesch Nemeth Gabriela, Kaesmacher Johannes, Grunder Lorenz, Cimflova Petra, Piechowiak Eike, Seiffge David, Steinlin Maja, Gralla Jan, Klein Andrea, Dobrocky Tomas
Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Clin Neuroradiol. 2025 Sep 9. doi: 10.1007/s00062-025-01563-y.
Pediatric acute ischemic stroke is a rare yet severe condition with multifactorial etiology, often associated with vasculopathies. Endovascular intervention in children with focal cerebral arteriopathy is seldom reported.
Our aim was to report feasibility of intracranial rescue stenting for the management of pediatric focal cerebral arteriopathy with flow-limiting stenosis.
We report a toddler with acute ischemic stroke due to flow-limiting focal cerebral arteriopathy of the left middle cerebral artery, treated with intracranial stenting. A comprehensive literature search was conducted in PubMed, Web of Science, Embase, and Scopus to identify case reports and series involving pediatric patients with acute ischemic stroke treated with intracranial stenting. Six cases met inclusion criteria. Extracted data included demographics (age, sex), clinical presentation, time of onset, medical history, occlusion location and etiology, stent type, pre- and post-stent NIHSS scores, antiplatelet therapy, and clinical outcomes at follow-up.
A total of six pediatric acute ischemic stroke cases with intracranial stent deployment in the acute stage were analyzed. The supraclinoid internal carotid artery was the most common site of stent deployment (4/6), while intracranial dissection was the most frequent cause of vessel occlusion (3/6). All included patients achieved resolution of the initial neurological deficit on follow-up (range: 6 weeks to 6 months). Variation in the use of intraoperative and postoperative antiplatelet regimens was observed.
This case demonstrates off-label rescue stenting in pediatric acute ischemic stroke due to focal cerebral arteriopathy, emphasizing the importance of individualized multidisciplinary management in this rare setting.
小儿急性缺血性卒中是一种病因多因素的罕见但严重的疾病，常与血管病变相关。关于小儿局灶性脑动脉病变的血管内介入治疗报道较少。
我们的目的是报告颅内抢救性支架置入术治疗小儿局灶性脑动脉病变伴血流限制性狭窄的可行性。
我们报告了一名因左大脑中动脉血流限制性局灶性脑动脉病变导致急性缺血性卒中的幼儿，接受了颅内支架置入术治疗。在PubMed、科学网、Embase和Scopus上进行了全面的文献检索，以确定涉及接受颅内支架置入术治疗的小儿急性缺血性卒中患者的病例报告和系列研究。6例符合纳入标准。提取的数据包括人口统计学信息（年龄、性别）、临床表现、发病时间、病史、闭塞部位和病因、支架类型、支架置入前后的美国国立卫生研究院卒中量表（NIHSS）评分、抗血小板治疗以及随访时的临床结局。
共分析了6例急性期进行颅内支架置入的小儿急性缺血性卒中病例。床突上段颈内动脉是最常见的支架置入部位（4/6），而颅内夹层是最常见的血管闭塞原因（3/6）。所有纳入患者在随访时（范围：6周至6个月）初始神经功能缺损均得到缓解。观察到术中及术后抗血小板方案使用的差异。
本病例展示了因局灶性脑动脉病变导致的小儿急性缺血性卒中的超说明书抢救性支架置入术，强调了在这种罕见情况下个体化多学科管理的重要性。
