Mechanical Thrombectomy for Acute Stroke in a 2-Month-Old Patient and Review of the Literature in Infancy

 

 Buy Article Permissions and Reprints

Abstract

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.

Note

Informed consent was obtained from the patient's legal guardian for this publication.

Publication History

Received: 24 March 2022

Accepted: 28 April 2022

Accepted Manuscript online:
05 May 2022

Article published online:
28 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Ferriero DM, Fullerton HJ, Bernard TJ. et al; American Heart Association Stroke Council and Council on Cardiovascular and Stroke Nursing. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2019; 50 (03) e51-e96
  CrossrefPubMedGoogle Scholar
• 2 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
  CrossrefPubMedGoogle Scholar
• 3 Futch HS, Corliss BM, Polifka AJ, Hoh BL, Fox WC. Solitaire stent retriever mechanical thrombectomy in a 6-month-old patient with acute occlusion of the internal carotid artery terminus: case report. World Neurosurg 2019; 126: 631-637
  CrossrefPubMedGoogle Scholar
• 4 Lee S, Heit JJ, Albers GW. et al. Neuroimaging selection for thrombectomy in pediatric stroke: a single-center experience. J Neurointerv Surg 2019; 11 (09) 940-946
  CrossrefPubMedGoogle Scholar
• 5 Sun LR, Pearl M, Bahouth MN. et al. Mechanical thrombectomy in an infant with acute embolic stroke. Pediatr Neurol 2018; 82: 53-54
  CrossrefPubMedGoogle Scholar
• 6 van Es ACGM, Hunfeld MAW, van den Wijngaard I. et al; MR CLEAN Registry Investigators. Endovascular treatment for acute ischemic stroke in children: experience from the MR CLEAN registry. Stroke 2021; 52 (03) 781-788
  CrossrefPubMedGoogle Scholar
• 7 Shoirah H, Shallwani H, Siddiqui AH. et al. Endovascular thrombectomy in pediatric patients with large vessel occlusion. J Neurointerv Surg 2019; 11 (07) 729-732
  CrossrefPubMedGoogle Scholar
• 8 Wilkinson DA, Pandey AS, Garton HJ. et al. Late recanalization of basilar artery occlusion in a previously healthy 17-month-old child. BMJ Case Rep 2017; 2017: bcr2017013277
  CrossrefPubMedGoogle Scholar
• 9 Savastano L, Gemmete JJ, Pandey AS, Roark C, Chaudhary N. Acute ischemic stroke in a child due to basilar artery occlusion treated successfully with a stent retriever. BMJ Case Rep 2015; 2015: bcr2015011821
  CrossrefPubMedGoogle Scholar
• 10 Nicosia G, Cicala D, Mirone G. et al. Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature. Childs Nerv Syst 2017; 33 (02) 349-355
  CrossrefPubMedGoogle Scholar
• 11 Zeleňák K, Matasova Jr K, Bobulova A, Matasova K. Mechanical and aspiration thrombectomy in a 2-day-old neonate with perinatal stroke. Clin Neuroradiol 2022; 32 (02) 577-580
  CrossrefPubMedGoogle Scholar
• 12 Stracke CP, Meyer L, Schwindt W, Ranft A, Straeter R. Case report: successful mechanical thrombectomy in a newborn with basilar artery occlusion. Front Neurol 2022; 12: 790486
  CrossrefPubMedGoogle Scholar
• 13 Sun LR, Felling RJ, Pearl MS. Endovascular mechanical thrombectomy for acute stroke in young children. J Neurointerv Surg 2019; 11 (06) 554-558
  CrossrefPubMedGoogle Scholar
• 14 Sun LR, Harrar D, Drocton G, Castillo-Pinto C, Gailloud P, Pearl MS. Endovascular therapy for acute stroke in children: age and size technical limitations. J Neurointerv Surg 2021; 13 (09) 794-798
  CrossrefPubMedGoogle Scholar
• 15 Sporns PB, Sträter R, Minnerup J. et al. Feasibility, safety, and outcome of endovascular recanalization in childhood stroke: the Save ChildS study. JAMA Neurol 2020; 77 (01) 25-34
  CrossrefPubMedGoogle Scholar