What is the Role of Mechanical Thrombectomy in Childhood Stroke?

Pediatr Neurol. 2019 Jun;95:19-25. doi: 10.1016/j.pediatrneurol.2019.01.009. Epub 2019 Jan 17.

Abstract

Background: Like adults, most children have lifelong morbidity after stroke. Revascularization therapies such as intravenous tissue plasminogen activator and mechanical thrombectomy may be options to decrease this morbidity in selected children, although currently there are no evidence-based recommendations to guide treatment. The utility and safety of mechanical thrombectomy in childhood stroke is unknown because of the lack of safety trials, case-controlled trials, and comprehensive retrospective studies. As such, the current rationale for the use of mechanical thrombectomy in childhood is based on extrapolation from adult experience, as well as consensus at individual institutions with many centers deciding care on a case-by-case basis. Nevertheless, the increasing use of recanalization therapies in appropriately selected adults with acute arterial ischemic stroke has led to an increase in consideration and use in childhood, and there are enough case reports and series, as well as experience, to suggest that some children with large vessel occlusion will likely benefit.

Methods: We reviewed current literature regarding mechanical thrombectomy in childhood.

Results: There are differences between pediatric and adult stroke which may impact safety, efficacy, and individual decision-making, including patient size, pathophysiology of stroke, deficit, experience, and lack of data regarding natural history of stroke in children.

Conclusions: Hospitals planning to perform mechanical thrombectomy in children should establish local procedures and guidelines for considering thrombectomy. In our experience, care is best provided through multidisciplinary teams including a pediatric vascular neurologist, neurointerventionalist with pediatric experience, and pediatric neurocritical care.

Keywords: Arterial ischemic stroke; Childhood stroke; Mechanical thrombectomy; Recanalization therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Child
  • Clinical Decision-Making / methods
  • Humans
  • Mechanical Thrombolysis / methods*
  • Mechanical Thrombolysis / trends
  • Neuroimaging / methods
  • Neuroimaging / trends
  • Stroke / diagnostic imaging*
  • Stroke / surgery*