Top

Child's Nervous System

Published in:

01-05-2014 | Case Report

Modern endovascular treatments of occlusive pediatric acute ischemic strokes: case series and review of the literature

Authors: Yin C. Hu, Chandril Chugh, Dhruve Jeevan, John L. Gillick, Stephan Marks, Michael F. Stiefel

Published in: Child's Nervous System | Issue 5/2014

Abstract

Purpose

Literature on the endovascular treatment of occlusive acute ischemic stroke (AIS) in the pediatric population remains nebulous. Clinical trials evaluating the role of systemic and intra-arterial thrombolysis, and mechanical thrombectomy have been strictly isolated to the adult population and largely unknown in their safety and efficacy in the pediatric group.

Methods

The authors present a review of the literature and their own two cases of occlusive acute ischemic stroke in children younger than the age of 10 years who were treated with modern endovascular devices, specifically with stent retrievers, and discuss their clinical and technical considerations as well as their limitations.

Results

In both pediatric patients, a combination of stent retriever and Penumbra aspiration were used to achieve Thrombolysis In Cerebral Infarction (TICI) 2a or greater with reduction of overall stroke burden. A reduction of National Institutes of Health Stroke Scale (NIHSS) of 8 or greater was achieved at discharge. At 3-month follow-up, the patients had a NIHSS of 6 and 2, respectively. One patient continued to improve from NIHSS of 6 to 3 at 6 months.

Conclusion

In carefully, selected pediatric patients, modern endovascular techniques may be used to treat occlusive pediatric AIS. However, larger clinical trials are needed to evaluate the overall safety and effectiveness.

Lo W, Zamel K, Ponnappa K, Allen A, Chisolm D, Tang M, Kerlin B, Yeates KO (2008) The cost of pediatric stroke care and rehabilitation. Stroke 39(1):161–165. doi:10.1161/STROKEAHA.107.497420 PubMedCrossRef

Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER, American Heart Association Stroke C, Council on Cardiovascular Disease in the Y (2008) 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 39(9):2644–2691. doi:10.1161/STROKEAHA.108.189696 PubMedCrossRef

Monagle P, Chan A, Massicotte P, Chalmers E, Michelson AD (2004) Antithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(3 Suppl):645S–687S. doi:10.1378/chest.126.3_suppl.645S PubMedCrossRef

Royal College of Physicians PSWG (2004) Stroke in childhood: clinical guidelines for diagnosis, management, and rehabilitation.

Mallick AA, O’Callaghan FJ (2010) The epidemiology of childhood stroke. Eur J Paediatr Neurol 14(3):197–205. doi:10.1016/j.ejpn.2009.09.006 PubMedCrossRef

deVeber GA, MacGregor D, Curtis R, Mayank S (2000) Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 15(5):316–324PubMedCrossRef

Ganesan V, Prengler M, McShane MA, Wade AM, Kirkham FJ (2003) Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol 53(2):167–173. doi:10.1002/ana.10423 PubMedCrossRef

Goldenberg NA, Bernard TJ, Fullerton HJ, Gordon A, de Veber G, International Pediatric Stroke Study G (2009) Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 8(12):1120–1127. doi:10.1016/S1474-4422(09)70241-8 PubMedCrossRef

Khestanov AK, Totikov VZ, Kakabadze SA, Dzgoeva DB, Gabisov AG, Sharifov IU (2002) A giant neurilemmoma of the stomach complicated by bleeding. Vestn Khir Im I I Grek 161(5):94–95PubMed

10.

McGlennan C, Ganesan V (2008) Delays in investigation and management of acute arterial ischaemic stroke in children. Dev Med Child Neurol 50(7):537–540. doi:10.1111/j.1469-8749.2008.03012.x PubMedCrossRef

11.

Srinivasan J, Miller SP, Phan TG, Mackay MT (2009) Delayed recognition of initial stroke in children: need for increased awareness. Pediatrics 124(2):e227–234. doi:10.1542/peds.2008-3544 PubMedCrossRef

12.

Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, Jauch EC, Jovin TG, Yan B, Silver FL, von Kummer R, Molina CA, Demaerschalk BM, Budzik R, Clark WM, Zaidat OO, Malisch TW, Goyal M, Schonewille WJ, Mazighi M, Engelter ST, Anderson C, Spilker J, Carrozzella J, Ryckborst KJ, Janis LS, Martin RH, Foster LD, Tomsick TA, Interventional Management of Stroke IIII (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368(10):893–903. doi:10.1056/NEJMoa1214300 PubMedCentralPubMedCrossRef

13.

Amlie-Lefond C, Bernard TJ, Sebire G, Friedman NR, Heyer GL, Lerner NB, DeVeber G, Fullerton HJ, International Pediatric Stroke Study G (2009) Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation 119(10):1417–1423. doi:10.1161/CIRCULATIONAHA.108.806307 PubMedCrossRef

14.

Beslow LA, Licht DJ, Smith SE, Storm PB, Heuer GG, Zimmerman RA, Feiler AM, Kasner SE, Ichord RN, Jordan LC (2010) Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study. Stroke 41(2):313–318. doi:10.1161/STROKEAHA.109.568071 PubMedCentralPubMedCrossRef

15.

Fullerton HJ, Wu YW, Sidney S, Johnston SC (2007) Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics 119(3):495–501. doi:10.1542/peds.2006-2791 PubMedCrossRef

16.

Sebire G, Meyer L, Chabrier S (1999) Varicella as a risk factor for cerebral infarction in childhood: a case–control study. Ann Neurol 45(5):679–680PubMedCrossRef

17.

Hills NKJS, Sidney S, Fullerton HJ (2009) Minor infection predisposes to arterial ischemic stroke in children. Stroke 40:e124CrossRef

18.

Amlie-Lefond C, Chan AK, Kirton A, deVeber G, Hovinga CA, Ichord R, Stephens D, Zaidat OO, Thrombolysis in Pediatric Stroke I (2009) Thrombolysis in acute childhood stroke: design and challenges of the thrombolysis in pediatric stroke clinical trial. Neuroepidemiology 32(4):279–286. doi:10.1159/000203076 PubMedCrossRef

19.

Amlie-Lefond C, de Veber G, Chan AK, Benedict S, Bernard T, Carpenter J, Dowling MM, Fullerton H, Hovinga C, Kirton A, Lo W, Zamel K, Ichord R, International Pediatric Stroke S (2009) Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 8(6):530–536. doi:10.1016/S1474-4422(09)70106-1 PubMedCrossRef

20.

Goldenberg NA, Hathaway WE, Jacobson L, McFarland K, Manco-Johnson MJ (2006) Influence of factor VIII on overall coagulability and fibrinolytic potential of haemophilic plasma as measured by global assay: monitoring in haemophilia A. Haemophilia 12(6):605–614. doi:10.1111/j.1365-2516.2006.01345.x PubMedCrossRef

21.

Mokin M, Dumont TM, Veznedaroglu E, Binning MJ, Liebman KM, Fessler RD, To CY, Turner RD, Turk AS, Chaudry MI, Arthur AS, Fox BD, Hanel RA, Tawk RG, Kan P, Gaughen JR Jr, Lanzino G, Lopes DK, Chen M, Moftakhar R, Billingsley JT, Ringer AJ, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI (2013) Solitaire FR thrombectomy for acute ischemic stroke: retrospective multicenter analysis of early postmarket experience after FDA approval. Neurosurgery. doi:10.1227/NEU.0b013e31828e211d

22.

Smith AA, Jacobson LJ, Miller BI, Hathaway WE, Manco-Johnson MJ (2003) A new euglobulin clot lysis assay for global fibrinolysis. Thromb Res 112(5–6):329–337. doi:10.1016/j.thromres.2004.01.001 PubMedCrossRef

23.

Turk AS 3rd, Campbell JM, Spiotta A, Vargas J, Turner RD, Chaudry MI, Battenhouse H, Holmstedt CA, Jauch E (2013) An investigation of the cost and benefit of mechanical thrombectomy for endovascular treatment of acute ischemic stroke. J Neurointerv Surg. doi:10.1136/neurintsurg-2012-010616

24.

Ellis MJ, Amlie-Lefond C, Orbach DB (2012) Endovascular therapy in children with acute ischemic stroke: review and recommendations. Neurology 79(13 Suppl 1):S158–164. doi:10.1212/WNL.0b013e31826958bf PubMedCrossRef

25.

Nister M, Hammacher A, Mellstrom K, Siegbahn A, Ronnstrand L, Westermark B, Heldin CH (1988) A glioma-derived PDGF A chain homodimer has different functional activities from a PDGF AB heterodimer purified from human platelets. Cell 52(6):791–799PubMedCrossRef

26.

Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS, Trialists T (2012) Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380(9849):1231–1240. doi:10.1016/S0140-6736(12)61299-9 PubMedCrossRef

27.

Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, Lutsep HL, Rymer MM, Higashida RT, Starkman S, Gobin YP, Multi MI, Frei D, Grobelny T, Hellinger F, Huddle D, Kidwell C, Koroshetz W, Marks M, Nesbit G, Silverman IE (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39(4):1205–1212. doi:10.1161/STROKEAHA.107.497115 PubMedCrossRef

28.

Felker MV, Zimmer JA, Golomb MR (2010) Failure of a clot retrieval device in an adolescent stroke patient. Pediatr Neurol 43(6):435–438. doi:10.1016/j.pediatrneurol.2010.06.010 PubMedCrossRef

29.

Grunwald IQ, Walter S, Shamdeen MG, Dautermann A, Roth C, Haass A, Bolar LJ, Reith W, Kuhn AL, Papanagiotou P (2010) New mechanical recanalization devices—the future in pediatric stroke treatment? J Invasive Cardiol 22(2):63–66PubMed

30.

Kirton A, Wong JH, Mah J, Ross BC, Kennedy J, Bell K, Hill MD (2003) Successful endovascular therapy for acute basilar thrombosis in an adolescent. Pediatrics 112(3 Pt 1):e248–251PubMedCrossRef

31.

Tatum J, Farid H, Cooke D, Fullerton H, Smith W, Higashida R, Halbach VV, Dowd C (2013) Mechanical embolectomy for treatment of large vessel acute ischemic stroke in children. J Neurointerv Surg 5(2):128–134. doi:10.1136/neurintsurg-2011-010100 PubMedCrossRef

32.

Turk AS, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D, Siddiqui A, Mokin M, Dewan M, Woo H, Turner R, Hawk H, Miranpuri A, Chaudry I (2013) Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. doi:10.1136/neurintsurg-2013-010713

Title: Modern endovascular treatments of occlusive pediatric acute ischemic strokes: case series and review of the literature
Authors: Yin C. Hu
Chandril Chugh
Dhruve Jeevan
John L. Gillick
Stephan Marks
Michael F. Stiefel
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 5/2014
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-013-2313-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Modern endovascular treatments of occlusive pediatric acute ischemic strokes: case series and review of the literature

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2014

Preliminary experience with diffusion tensor imaging before and after re-irradiation treatments in children with progressive diffuse pontine glioma

Neuroimaging findings of retroclival hemorrhage in children: a diagnostic conundrum

Thoracolumbar spinal tuberculosis in children with severe post-tubercular kyphotic deformities treated by single-stage closing–opening wedge osteotomy: preliminary report a 4-year follow-up of 12 patients

The inflammatory cellular constituents of foetal and infant leptomeninges: a survey of hospital-based autopsies without trauma

Hypertrophic olivary degeneration with gadolinium enhancement after posterior fossa surgery in a child with medulloblastoma

Involuntary movement in pediatric moyamoya disease patients: consideration of pathogenetic mechanism using neuroimaging studies