title: Modern endovascular treatments of occlusive pediatric acute ischemic strokes: case series and review of the literature.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Neurovascular Institute, Westchester Medical Center, 100 Woods Road, Taylor Pavillion, Suite E-119, Valhalla, NY, 10595, USA, HuY@wcmc.com.
authors.forename: Yin C
authors.initials: YC
authors.lastname: Hu
authors.forename: Chandril
authors.initials: C
authors.lastname: Chugh
authors.forename: Dhruve
authors.initials: D
authors.lastname: Jeevan
authors.forename: John L
authors.initials: JL
authors.lastname: Gillick
authors.forename: Stephan
authors.initials: S
authors.lastname: Marks
authors.forename: Michael F
authors.initials: MF
authors.lastname: Stiefel
mesh_terms: D002545:Brain Ischemia / Q000150:complications; D002533:Cerebral Angiography; D002648:Child; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D020521:Stroke / Q000209:etiology / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents