Mechanical Thrombectomy for Pediatric Acute Ischemic Stroke With Large Vessel Occlusion: Technical Guide and Case Series

BACKGROUND: Pediatric acute ischemic stroke is a rare entity, and mechanical thrombectomy (MT) in this population can be technically challenging. We aim to discuss key technical aspects of pediatric MT and report our experience in this population. METHODS: Pediatric patients were identified from our prospectively maintained database of MT patients. Inclusion criteria were pediatric patients’ age >28 days and <18 years undergoing MT for large vessel occlusion at a single center between 2012 and 2023. RESULTS: Seven patients were included in this case series. Patient age ranged from ≈1 to 17 (10.0±6.2) years. Causes of large vessel occlusion included hypercoagulability disorders, cardiac disorders, and iatrogenic during neurointerventions. Most patients (n=5, 71.4%) had middle cerebral artery or internal carotid artery occlusions. Six patients (85.7%) were successfully treated with MT, achieving modified Thrombolysis in Cerebral Infarction grade 2C or above. Five patients were treated with stent retriever MT and the other 2 patients with aspiration MT alone, with an average of 2.3±1.5 passes total. Five patients (71.4%) made an excellent clinical recovery with a pediatric modified Rankin Scale score ≤2 at last outpatient follow-up (pediatric modified Rankin Scale score, 1.8±1.2). Average follow-up duration was 2.7±2.4 years. CONCLUSIONS: Recent advancements in catheter technology have facilitated MT in pediatric patients. Pediatric MT appears to be safe and effective for treating cerebral large vessel occlusions; however, technical limitations can arise secondary to small vessel diameters. A technical guide based on patient age and femoral artery diameter is provided.