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Mechanical Thrombectomy for Acute Stroke in a 2-Month-Old Patient and Review of the Literature in Infancy
Neuropediatrics ( IF 1.1 ) Pub Date : 2022-07-24 , DOI: 10.1055/s-0042-1750735
Alberto Rodríguez-López 1 , Isabel Gimeno 2 , Sara Vila 2 , Andrea Seoane 2 , Federico Ballenilla 3 , Ana Ramos 3 , Amaya Hilario 3 , Noemí Núñez 1 , Ana Camacho 1 , Rogelio Simón 1
Affiliation  

Mechanical thrombectomy (MT) in pediatric stroke is supported by studies in adults, but there is controversy regarding younger patients. The main growth of intracranial vessels occurs up to 2 years when there can be more difficulties in MT.

Description of the MT performed in a 2-month-old patient—the youngest infant published to date. We also review the literature on MT for stroke in infants.

A 2-month-old patient presented with an awakening stroke secondary to an occlusion of the M1 segment of the left middle cerebral artery. A successful MT was performed with an aspiration device without clinically significant complications. An etiological study was completed, and neuroimaging showed focal cerebral arteriopathy. The 3-month outcome was excellent: the pediatric modified Rankin score was 0.

Including this case, MT for acute stroke has been reported in only 10 infants. MT was successful in 90%, mostly using adult conventional stent retrievers. There were complications only in patients with mechanical circulatory support (MCS) devices; three patients died due to hemorrhagic transformation after MT and one patient died due to recurrent ischemic stroke.

MT seems effective and safe in infants similarly to other pediatric ages. In children under 2 years of age, the presence of comorbidities requiring MCS devices is the main factor underlying poor prognosis.



中文翻译:

2个月大急性卒中患者的机械血栓切除术及婴儿期文献回顾

成人研究支持小儿卒中的机械血栓切除术 (MT),但对年轻患者存在争议。颅内血管的主要生长发生长达 2 年,此时 MT 可能会遇到更多困难。

对一名 2 个月大的患者(迄今为止发表的最小婴儿)进行的 MT 描述。我们还回顾了有关 MT 治疗婴儿卒中的文献。

一名 2 个月大的患者因左侧大脑中动脉 M1 段闭塞而出现苏醒性中风。成功的 MT 使用抽吸装置进行,没有明显的临床并发症。完成了病因学研究,神经影像学显示局灶性脑动脉病。3 个月的结果非常好:儿科改良 Rankin 评分为 0。

包括本例在内,仅报告了 10 名婴儿发生急性卒中的 MT。MT 成功率达 90%,主要使用成人常规支架取栓器。仅在使用机械循环支持 (MCS) 装置的患者中出现并发症;3例患者因MT后出血性转化死亡,1例患者因复发性缺血性卒中死亡。

与其他儿科年龄相似,MT 似乎对婴儿有效且安全。在 2 岁以下的儿童中,存在需要 MCS 装置的合并症是预后不良的主要因素。

更新日期:2022-07-25
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