Endovascular treatment of stroke in children under 2 years with heart failure and ventricular assist device

Abstract

<jats:sec><jats:title>Introduction</jats:title><jats:p> Strokes in children are characterised by a high mortality rate while, at the same time, the low number of cases makes it difficult to gain practical experience. As heart disease is the most common risk factor, and as more and more cardiological interventions are being carried out, an increase in the incidence of paediatric stroke is expected. In some cases a transplant is required. While waiting for a donor, the use of ventricular assist devices may be necessary. These present with a high rate of neurological complications. We present two cases of children under 2 years of age awaiting heart transplantation supported by ventricular assist devices who had a stroke which was treated by endovascular techniques. Case 1: A 16-month-old boy with restrictive cardiomyopathy who was listed for a cardiac transplant. At 20 months he required an implantation of an external biventricular support device (Berlin Heart) and had a left hemisphere stroke at 23 months. An intra-arterial approach was used and produced good clinical results. One month later, a heart transplant was performed successfully. Case 2: An 18-month-old girl with non-compacted dilated cardiomyopathy included in the cardiac transplant programme and in need of a Levitronix Centrimag ventricular assist device presented with an acute left hemisphere stroke at 23 months. An intra-arterial procedure was carried out leading to positive clinical results except for residual right hypertonia. Seven months later she received her transplant. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> As a result of the difficulty in performing arterial puncture, the small vessel calibre and the limitation in the use of iodated contrast, there are certain limitations to endovascular treatment of strokes in children that can lead to complications. A multidisciplinary approach to managing such cases would be helpful. </jats:p></jats:sec>

Childhood strokes in China describing clinical characteristics, risk factors and performance indicators: a case-series study

“…Although, several studies have shown that Open access endovascular clot retrieval and thrombolysis in adult stroke and in some children have excellent results. [20][21][22][23][24][25][26][27][28][29] In our study, no thrombolysis or mechanical thrombectomy was used and antithrombotic and anticoagulation use was only observed in 17.44% and 5.23% of patients who had an AIS. The low rate of thrombolysis and antithrombotic use may be related to delayed hospital visit and delayed diagnosis.…”

“…Onset-to-door time delay in our patients may be related to the aetiologies, as AIS was more likely to be caused by moyamoya in our study. Although, several studies have shown that endovascular clot retrieval and thrombolysis in adult stroke and in some children have excellent results 20–29. In our study, no thrombolysis or mechanical thrombectomy was used and antithrombotic and anticoagulation use was only observed in 17.44% and 5.23% of patients who had an AIS.…”