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Successful Clinical Treatment of Child Stroke Using Mechanical Embolectomy

      Abstract

      Background

      Stroke in childhood is less common than stroke in adults, but recent study estimate incidences up to 13/100,000. Mortality is decreasing but morbidity remains very high, with variable effects for two thirds of patients. Recent guidelines for optimal treatment in childhood stroke recommend advise against the use of thrombolysis, except for specific research protocols. There is no recommendation about intra-arterial thrombolysis or mechanical embolectomy. Various investigators have published cases of mechanical embolectomy in adult stroke, and a few cases of children are also reported.

      PATIENT

      We report a case of mechanical embolectomy 6 hours after a basilar artery occlusion in a healthy 7-year-old child. RESULT: He presented a successful medical outcome and had made a complete recovery.

      Conclusion

      This patient and the 10 published pediatric cases suggest mechanical embolectomy can be successfully used to treat basilar artery occlusion in children with coordination of neurology and interventional radiology services.

      Keywords

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      References

        • Goldenberg N.A.
        • Bernard T.J.
        • Fullerton H.J.
        • Gordon A.
        • deVeber G.
        Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study.
        Lancet Neurol. 2009; 8: 1120-1127
        • Rafay M.F.
        • Pontigon A.M.
        • Chiang J.
        • et al.
        Delay to diagnosis in acute pediatric arterial ischemic stroke.
        Stroke. 2009; 40: 58-64
        • Monagle P.
        • Chalmers E.
        • Chan A.
        • et al.
        Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition).
        Chest. 2008; 133: 887S-968S
        • Roach E.S.
        • Golomb M.R.
        • Adams R.
        • et al.
        Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young.
        Stroke. 2008; 39: 2644-2691
        • Tsivgoulis G.
        • Horton J.A.
        • Ness J.M.
        • et al.
        Intravenous thrombolysis followed by intra-arterial thrombolysis and mechanical thrombectomy for the treatment of pediatric ischemic stroke.
        J Neurol Sci. 2008; 275: 151-153
        • Grunwald I.Q.
        • Walter S.
        • Shamdeen M.G.
        • et al.
        New mechanical recanalization devices - the future in pediatric stroke treatment?.
        J Invasive Cardiol. 2010; 22: 63-66
        • Tatum J.
        • Farid H.
        • Cooke D.
        • et al.
        Mechanical embolectomy for treatment of large vessel acute ischemic stroke in children.
        J Neurointerventional Surg. 2013; 5: 128-134
        • Fink J.
        • Sonnenborg L.
        • Larsen L.L.
        • Born A.P.
        • Holtmannspotter M.
        • Kondziella D.
        Basilar artery thrombosis in a child treated with intravenous tissue plasminogen activator and endovascular mechanical thrombectomy.
        J Child Neurol. 2012; (Epub 2012 Oct 3)
        • Goeggel Simonetti B.G.
        • Ritter B.
        • Gautschi M.
        • et al.
        Basilar artery stroke in childhood.
        Dev Med Child Neurol. 2013; 55: 65-70
        • Adams Jr., H.P.
        • del Zoppo G.
        • Alberts M.J.
        • et al.
        Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
        Stroke. 2007; 38: 1655-1711
        • Smith W.S.
        • Sung G.
        • Starkman S.
        • et al.
        Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial.
        Stroke. 2005; 36: 1432-1438
        • Furlan A.
        • Higashida R.
        • Wechsler L.
        • et al.
        Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism.
        JAMA. 1999; 282: 2003-2011
        • Vendrell J.F.
        • Mernes R.
        • Nagot N.
        • et al.
        Evaluation of an intravenous-endovascular strategy in patients with acute proximal middle cerebral artery occlusion.
        AJNR Am J Neuroradiol. 2013; 34: 603-608
        • Condie J.
        • Shaibani A.
        • Wainwright M.S.
        Successful treatment of recurrent basilar artery occlusion with intra-arterial thrombolysis and vertebral artery coiling in a child.
        Neurocritical Care. 2012; 16: 158-162
        • Ellis M.J.
        • Amlie-Lefond C.
        • Orbach D.B.
        Endovascular therapy in children with acute ischemic stroke: review and recommendations.
        Neurology. 2012; 79: S158-S164