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

Abstract

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.

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

“…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).…”

“…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 …”

Acute management of childhood stroke

“…Children receiving mechanical circulatory support are at particularly high risks for cardioembolic stroke and due to anticoagulation, are often not candidates for thrombolysis, but may be candidates for thrombectomy [40 ▪ ]. Although successful thrombectomies have been described in infants, especially those on mechanical support, minimum age and size for thrombectomy consideration have not been established and should be determined at individual sites based on the experience of the interventionalist [41 ▪ ]. An important practical consideration is that the surgical equipment is not optimized for children; this concern generally decreases by age 5 as children's blood vessels reach near-adult size, though complications such as puncture-site vasospasm even in younger children are low [37].…”