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. 2023 Oct 5:11:100528.
doi: 10.1016/j.ejro.2023.100528. eCollection 2023 Dec.

Endovascular treatment of acute ischemic stroke in childhood: A comprehensive literature review based on the experience of a single center

Guglielmo Pero  1 , Francesco Ruggieri  2 , Antonio Macera  1 , Mariangela Piano  1 , Caroline Regna Gladin  1 , Cristina Motto  3 , Amedeo Cervo  1 , Arturo Chieregato  2
Affiliations

Endovascular treatment of acute ischemic stroke in childhood: A comprehensive literature review based on the experience of a single center

Guglielmo Pero et al. Eur J Radiol Open. .

Abstract

Acute ischemic stroke (AIS) in childhood is a relatively rare but significant condition that can result in long-term disabilities. There is a lack of standardized strategies for diagnosing and treating pediatric AIS due to limited evidence-based data on thrombolytic and endovascular treatments in children. This comprehensive literature review focuses on the experience of a single center in Italy and aims to highlight the main peculiarities of endovascular treatment (EVT) for AIS in childhood. The review covers the diagnostic workup, the endovascular procedures, and the need for a specific thrombectomy program for pediatric AIS. The review discusses the indications and considerations for thrombectomy in children, including the risk of complications and the challenges of extrapolating results from adult studies. The diagnostic protocols for pediatric AIS are also discussed, emphasizing the use of MRI to avoid X-ray and contrast medium exposure in children. The combination of intravenous thrombolysis and mechanical thrombectomy has been examined, considering the differences between pediatric and adult thrombi. Technical considerations related to the size of pediatric patients are addressed, including the use of large bore catheters and potential concerns with access points. The organization of a thrombectomy program for pediatric AIS is discussed, emphasizing the need for specialized facilities and expertise. Although evidence for EVT in the pediatric population is based on case series, the importance of specialized centers and the lack of validated guidelines are evident.

Keywords: Embolic stroke; Focal cerebral arteriopathy; Intracranial dissection; Pediatric stroke; Thrombectomy in children.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
: A: a CTA MIP coronal reconstruction showing the occlusion of the distal segment of the intracranial internal carotid artery with good collaterals. B the occlusion as shown by the DSA in lateral projection. C: a combined technique with stent-retriever and a aspiration catheter was used. D: the result of the thrombectomy with complete recanalization.
See this image and copyright information in PMC

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