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Modern endovascular treatments of occlusive pediatric acute ischemic strokes: case series and review of the literature

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Abstract

Purpose

Literature on the endovascular treatment of occlusive acute ischemic stroke (AIS) in the pediatric population remains nebulous. Clinical trials evaluating the role of systemic and intra-arterial thrombolysis, and mechanical thrombectomy have been strictly isolated to the adult population and largely unknown in their safety and efficacy in the pediatric group.

Methods

The authors present a review of the literature and their own two cases of occlusive acute ischemic stroke in children younger than the age of 10 years who were treated with modern endovascular devices, specifically with stent retrievers, and discuss their clinical and technical considerations as well as their limitations.

Results

In both pediatric patients, a combination of stent retriever and Penumbra aspiration were used to achieve Thrombolysis In Cerebral Infarction (TICI) 2a or greater with reduction of overall stroke burden. A reduction of National Institutes of Health Stroke Scale (NIHSS) of 8 or greater was achieved at discharge. At 3-month follow-up, the patients had a NIHSS of 6 and 2, respectively. One patient continued to improve from NIHSS of 6 to 3 at 6 months.

Conclusion

In carefully, selected pediatric patients, modern endovascular techniques may be used to treat occlusive pediatric AIS. However, larger clinical trials are needed to evaluate the overall safety and effectiveness.

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Authors and Affiliations

  1. Neurovascular Institute, Westchester Medical Center, 100 Woods Road, Taylor Pavillion, Suite E-119, Valhalla, NY, 10595, USA

    Yin C. Hu, Chandril Chugh, Dhruve Jeevan, John L. Gillick & Michael F. Stiefel

  2. Department of Neurological Surgery, Division of Cerebrovascular and Endovascular Neurosurgery, New York Medical College, Valhalla, NY, USA

    Yin C. Hu, Dhruve Jeevan, John L. Gillick & Michael F. Stiefel

  3. Department of Neurology, Division of Stroke Neurology, New York Medical College, Valhalla, NY, USA

    Yin C. Hu, Stephan Marks & Michael F. Stiefel

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  1. Yin C. Hu
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  2. Chandril Chugh
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Correspondence to Yin C. Hu.

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Hu, Y.C., Chugh, C., Jeevan, D. et al. Modern endovascular treatments of occlusive pediatric acute ischemic strokes: case series and review of the literature. Childs Nerv Syst 30, 937–943 (2014). https://doi.org/10.1007/s00381-013-2313-3

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  • DOI: https://doi.org/10.1007/s00381-013-2313-3

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