Endovascular Treatment of Acute Ischemic Stroke in Patients Younger than 18 Years

Abstract

Purpose Rapid and effective revascularization is very important in the treatment of acute ischemic stroke (AIS). Endovascular treatment is a promising modality in the management of AIS in young patients.

Methods We evaluated the clinical and imaging records in 14 patients younger than 18 years presenting within 6 hours of AIS. They received endovascular therapy (ET) either by mechanical thrombectomy, thromboaspiration, or both (Solumbra) between July 2017 and June 2021. The National Institute of Health Stroke Scale (NIHSS) score was calculated on admission and before the discharge of all patients. The 90-day modified Rankin Scale (mRS) score on disability-free outcome was also evaluated.

Results The mean preprocedure NIHSS score was 10.78 ± 2.11 that improved to 4.5 ± 1.88 after the procedure. Thrombolysis in cerebral infarction (TICI) grade 2b and 3 blood flow could be established in 12 (85.72%) patients. One patient had TICI 2a flow and one patient had recurrent occlusion despite repeated recanalization (TICI grade 0). The disability-free outcome, mRS score at 90 days was 0 to 1 in 12 (85.72%) patients, mRS score 2 in one (7.14%) patient, and mRS score 3 in one patient (7.14%). We did not have any major complication related to the procedure.

Conclusion ET provides high rates of arterial recanalization and favorable disability-free outcomes in young patients with AIS.

Keywords

stroke in young - mechanical thrombectomy - thromboaspiration

• References

• 1 Kamalakannan S, Gudlavalleti ASV, Gudlavalleti VSM, Goenka S, Kuper H. Incidence & prevalence of stroke in India: a systematic review. Indian J Med Res 2017; 146 (02) 175-185
• 2 Biswas T. India unveils plans to improve stroke research and care. Lancet 2013; 381 (9862): 190
• 3 Mallick AA, Ganesan V, Kirkham FJ. et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol 2014; 13 (01) 35-43
• 4 Khalessi AA, Fargen KM, Lavine S, Mocco J. Commentary: societal statement on recent acute stroke intervention trials: results and implications. Neurosurgery 2013; 73 (02) E375-E379
• 5 Goyal M, Demchuk AM, Menon BK. et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372 (11) 1019-1030
• 6 Mijajlovic MD. Thrombolytic or endovascular therapy for acute ischemic stroke: time is brain. J Neurosci Rural Pract 2014; 5 (01) 3-5
• 7 Nogueira RG, Lutsep HL, Gupta R. et al; TREVO 2 Trialists. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 2012; 380 (9849): 1231-1240
• 8 Goeggel Simonetti B, Cavelti A, Arnold M. et al. Long-term outcome after arterial ischemic stroke in children and young adults. Neurology 2015; 84 (19) 1941-1947
• 9 Zanaty M, Chalouhi N, Starke RM. et al. Endovascular stroke intervention in the very young. Clin Neurol Neurosurg 2014; 127: 15-18
• 10 Bodey C, Goddard T, Patankar T. et al. Experience of mechanical thrombectomy for paediatric arterial ischaemic stroke. Eur J Paediatr Neurol 2014; 18 (06) 730-735
• 11 Chalouhi N, Tjoumakaris S, Starke RM. et al. Endovascular stroke intervention in young patients with large vessel occlusions. Neurosurg Focus 2014; 36 (01) E6
• 12 Wolpert SM, Bruckmann H, Greenlee R, Wechsler L, Pessin MS, del Zoppo GJ. Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group. AJNR Am J Neuroradiol 1993; 14 (01) 3-13
• 13 Saposnik G, Guzik AK, Reeves M, Ovbiagele B, Johnston SC. Stroke prognostication using age and NIH Stroke Scale: SPAN-100. Neurology 2013; 80 (01) 21-28
• 14 Natarajan SK, Snyder KV, Siddiqui AH, Ionita CC, Hopkins LN, Levy EI. Safety and effectiveness of endovascular therapy after 8 hours of acute ischemic stroke onset and wake-up strokes. Stroke 2009; 40 (10) 3269-3274
• 15 Campbell BCV, Donnan GA, Lees KR. et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. Lancet Neurol 2015; 14 (08) 846-854
• 16 Touma L, Filion KB, Sterling LH, Atallah R, Windle SB, Eisenberg MJ. Stent retrievers for the treatment of acute ischemic stroke: a systematic review and meta-analysis of randomized clinical trials. JAMA Neurol 2016; 73 (03) 275-281
• 17 Tsivgoulis G, Katsanos AH, Mavridis D, Magoufis G, Arthur A, Alexandrov AV. Mechanical thrombectomy improves functional outcomes independent of pretreatment with intravenous thrombolysis. Stroke 2016; 47 (06) 1661-1664
• 18 Saver JL, Goyal M, van der Lugt A. et al; HERMES Collaborators. HERMES Collaborators. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016; 316 (12) 1279-1288
• 19 Berkhemer OA, Fransen PS, Beumer D. et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (01) 11-20
• 20 Saver JL, Goyal M, Bonafe A. et al; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372 (24) 2285-2295
• 21 Campbell BC, Mitchell PJ, Kleinig TJ. et al. EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372 (11) 1009-1018
• 22 Jovin TG, Chamorro A, Cobo E. et al; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372 (24) 2296-2306
• 23 Waitzman AA, Posnick JC, Armstrong DC, Pron GE. Craniofacial skeletal measurements based on computed tomography: part II. Normal values and growth trends. Cleft Palate Craniofac J 1992; 29 (02) 118-128
• 24 He L, Ladner TR, Pruthi S. et al. Rule of 5: angiographic diameters of cervicocerebral arteries in children and compatibility with adult neurointerventional devices. J Neurointerv Surg 2016; 8 (10) 1067-1071
• 25 Arat YO, Arat A, Aydin K. Angiographic morphometry of internal carotid artery circulation in Turkish children. Turk Neurosurg 2015; 25 (04) 608-616
• 26 Bhogal P, Hellstern V, AlMatter M. et al. Mechanical thrombectomy in children and adolescents: report of five cases and literature review. Stroke Vasc Neurol 2018; 3 (04) 245-252
• 27 Barry M, Hallam DK, Bernard TJ, Amlie-Lefond C. What is the role of mechanical thrombectomy in childhood stroke?. Pediatr Neurol 2019; 95: 19-25
• 28 Bhatia K, Kortman H, Blair C. et al. Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series. J Neurosurg Pediatr 2019;
• 29 Sporns PB, Kemmling A, Hanning U. et al. Thrombectomy in childhood stroke. J Am Heart Assoc 2019; 8 (05) e011335
• 30 Cappellari M, Moretto G, Grazioli A, Ricciardi GK, Bovi P, Ciceri EFM. Primary versus secondary mechanical thrombectomy for anterior circulation stroke in children: an update. J Neuroradiol 2018; 45 (02) 102-107
• 31 Fragata I, Morais T, Silva R. et al. Endovascular treatment of pediatric ischemic stroke: a single center experience and review of the literature. Interv Neuroradiol 2021; 27 (01) 16-24
• 32 Sun LR, Felling RJ, Pearl MS. Endovascular mechanical thrombectomy for acute stroke in young children. J Neurointerv Surg 2019; 11 (06) 554-558
• 33 Goyal M, Menon BK, van Zwam WH. et al; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387 (10029): 1723-1731