Systemic thrombolytic therapy alone and in combination with mechanical revascularization in acute ischemic stroke in two children

Abstract

Thrombolytic therapy is not recommended for acute ischemic stroke (AIS) in patients under the age of 18 and published experience is limited. In this case report, we describe two children treated with systemic thrombolytic therapy. One child received additional mechanical revascularization and achieved a good clinical outcome. The differences in the fibrinolytic system and the different etiology of AIS in childhood may limit a simple extrapolation of the adult guidelines for systemic thrombolytic therapy. Acute multimodal imaging to clarify the etiology of AIS might help to select the most appropriate treatment modality.

Keywords: Acute stroke; Endovascular technique; Thrombolytic therapy.

Fig. 1

MRI immediately after interruption of the thrombolytic therapy: acute ischemic lesions of the ACA territory bilateral, and the left MCA. ∗ Lack of flow in the right ACA; ∗∗ lack of flow signal in several branches of the left MCA; ↔ intracranial stenosis of the left internal carotid artery.

Fig. 2

a Brain CT with hyperdense right MCA. b MRI with acute ischemic lesion in the right MCA territory. c Angiography with occlusion of the right ICA at the skull base, occlusion of the right ACA and partial occlusion of the right MCA. d Angiography with normal left ICA, ACA and MCA. e Angiography after mechanical revascularization with reestablished flow in the right MCA and branches. f MRI control at 5 months with residual infarction in the right MCA territory.