Low-profile mechanical thrombectomy devices for large vessel occlusion in pediatric ischemic stroke

• Published in: Journal of neurointerventional surgery Vol. 17; no. 6; p. 620
• Main Authors: Oushy, Soliman, Garton, Andrew, Orbach, Darren B, See, Alfred Pokmeng
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.06.2025
• Subjects: Adolescent; Brain Ischemia - surgery; Catheters; Child; Child, Preschool; Demographics; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Extracorporeal membrane oxygenation; Female; Humans; Infant; Intubation; Ischemia; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - surgery; Male; Mechanical Thrombolysis - instrumentation; Mechanical Thrombolysis - methods; Medical imaging; Patients; Pediatrics; Retrospective Studies; Stroke; Thrombectomy - instrumentation; Thrombectomy - methods; Thrombolytic drugs; Treatment Outcome; Veins & arteries; United States > US; California; Pediatrics; Stroke; Thrombectomy; Technique; Device
• ISSN: 1759-8478; 1759-8486
• DOI: 10.1136/jnis-2024-021574

Mechanical thrombectomy (MT) is a well-established treatment modality for large vessel occlusion (LVO) in adults, but there are limited data in the pediatric population. The rarity of the condition makes prospective trial design difficult, and therefore evaluation of MT devices and outcomes is sparse. In pediatric LVO cases, some newer devices may be appropriate for use in revascularization procedures. Furthermore, illustrative specific device-access combinations have rarely been presented in young patients under the age of 5 years. This was a single institution experience in intracranial MT procedures for pediatric acute ischemic stroke (AIS). A given procedure was included if there was an attempt at MT between 2015 and 2023. Sixteen endovascular procedures were performed in 15 patients with AIS, with a mean age of 7.4 years; eight patients were <5 years of age. MT was attempted in 15/16 (93.7%) procedures, including 11 (73.3%) in the anterior circulation and four (26.7%) in the posterior circulation; one case recanalized after medical treatment. The most common MT techniques were combined aspiration with a stentriever (n=10, 66.7%) and aspiration alone (n=3, 20%). Traditional stentrievers (4-6 mm) were used in seven cases and low-profile stentrievers in four cases. Improved reperfusion was achieved in all low-profile stentriever cases. Reperfusion of modified Thrombolysis in Cerebral Infaction ≥2b was obtained in 73.3% of cases, including 72.7% of those in which a stentriever was used. Low-profile thrombectomy devices may achieve similar revascularization results to other approaches in challenging clinical scenarios observed in younger children.