Case Report: Successful Mechanical Thrombectomy in a Newborn With Basilar Artery Occlusion

Stracke, Christian Paul; Meyer, Lukas; Schwindt, Wolfram; Ranft, Alexander; Sträeter, Ronald

doi:10.3389/fneur.2021.790486

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…The 68 included articles 9–77 were published between 2001 and 2023 (Supporting Information S2: File 2). The main articles included case reports ( n = 48, 71 patients), prospective cohort studies ( n = 7, 215 patients), literature reviews ( n = 5), retrospective cohort studies ( n = 6, 209 patients), case series ( n = 1, nine patients), and systematic reviews ( n = 1, 235 patients).…”

Section: Resultsmentioning

confidence: 99%

“…Tables 1, 2, and 3 present the main characteristics of the interventions and the evaluated outcomes. There were 11 reports describing the use of IVT 10,12,17,18,22,25,32,44,49,51,77 ; eight reports of the use of the intra‐arterial modality; 9,12,14,20,21,26,27,58 and 52 articles reporting interventions based on MT 13,15,16,19,23,24,26,29–43,45–50,52–57,59,61,63–77 …”

Section: Resultsmentioning

confidence: 99%

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A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

Garcia,

Zuliani,

Mendes‐Chillof

et al. 2023

Annals of the Child Neurology Society

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BackgroundManagement of pediatric stroke is challenging because of the paucity of data supporting the efficacy of interventions. This scoping review details the treatments available for the acute phase of stroke in pediatric patients with arterial ischemic stroke.Summary of ReviewOverall, 68 relevant articles were published between 2001 and 2023. The primary study included 48 case reports (n = 48). Eleven articles reported the use of intravenous thrombolysis (IVT) with alteplase, eight used intra‐arterial (IA) alteplase, and 52 reported mechanical thrombectomy (MT). IVT was administered to 195 patients with a median of 5.5 h of stroke onset, and only four (2.0%) had intracranial hemorrhage after alteplase treatment. Of the 11 articles, nine used 0.9 mg/kg IVT administered as a 10% bolus, with the remaining 90% administered over one hour, and one study used 0.54 mg/kg. IA was performed in 17 patients with a median of 5.05 h of stroke onset, and three individuals (17.6%) had intracranial hemorrhage. Of the eight reports that document IA, two used 0.9 mg/kg; one each used 0.16 mg/kg, 0.1 mg/kg, 0.6 mg/kg, 100 mg/day, and 10 mg/day; and one article documented the use of urokinase 750 000 IU. MT was used in 434 and 215 individuals in a previous systematic review, with a median of 11.82 h of stroke onset, and only 2.9% had intracranial hemorrhage after the treatment. Stent retrievers were used in 33 reports (63.5%) and aspiration retrievers were mentioned in 15 articles (28.8%). Overall, the outcomes ranged from complete to moderate recovery for all modalities.ConclusionsIVT and MT are safer than IA; however, despite the lack of clinical trials, all modalities seem effective in improving clinical recovery. To guide clinical practice and determine better intervention modalities, clinicians should note the key messages from this review, such as using magnetic resonance imaging in the acute phase and identifying key risk factors and presenting symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

Garcia,

Zuliani,

Mendes‐Chillof

et al. 2023

Annals of the Child Neurology Society

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“…To our knowledge, there are only two cases of MT in neonates published to date with a successful outcome. 11,12 MT in children under 2 years of age has been possible in large vessel occlusions in anterior and posterior circulation (basilar, internal carotid artery, M1 segment of MCA), but there is no experience in other segments such as the M2 segment. The same selection criteria and time windows as in adults have been used, being even broader in basilar stroke because there may be more collateral vessels in children, which delay tissue necrosis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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INTRODUCTION: 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 two years when there can be more difficulties in MT. METHODS: Description of the MT performed in a two-month-old patient—the youngest infant published to date. We also review the literature on MT for stroke in infants. RESULT: A two-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 three-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. CONCLUSION: MT seems effective and safe in infants similarly to other pediatric ages. In children under two years of age, the presence of comorbidities requiring MCS devices is the main factor underlying poor prognosis.

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“…To our knowledge, there are only two cases of MT in neonates published to date with a successful outcome. 11 12…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Case Report: Successful Mechanical Thrombectomy in a Newborn With Basilar Artery Occlusion

Cited by 10 publications

References 21 publications

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

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

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

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