title: Experience of mechanical thrombectomy for paediatric arterial ischaemic stroke.
abstract: BACKGROUND
  Paediatric arterial ischaemic stroke (AIS) is an important cause of acute neurological symptoms in children, it causes significant morbidity and is one of the top ten causes of childhood deaths. Consensus papers have suggested guidelines for the management of AIS in childhood, although none recommend thrombectomy. Despite this, children within our institution have undergone mechanical thrombectomy for large vessel occlusion. This is the first series of mechanical thrombectomy and outcomes performed in children in the U.K.
  
  
  METHODS
  We describe the endovascular management of paediatric arterial ischaemic stroke (AIS) in four children (5-15 years) with PedNIHSS > 17.
  
  
  RESULTS
  Three had basilar artery (BA) occlusion and one left middle cerebral artery (MCA) occlusion. All underwent uncomplicated thrombectomy followed by intravenous heparin. One had a successful second attempt. The BA cases underwent thrombectomy 17-36 h after symptom onset; the left MCA case <6 h after symptom onset. Modified Rankin Scale (MRS) was 0-3, 50% had MRS 0.
  
  
  CONCLUSIONS
  Adult AIS guidelines recommend IV recombinant tissue plasminogen activator (r-tPA) within 4.5 h of onset and intra-arterial r-tPA within 6 h; thrombectomy being reserved for carefully selected patients. Paediatric AIS recognition is problematic, often with delayed imaging. There is little evidence regarding efficacy of thrombectomy for paediatric AIS. Our experience suggests there may be a role for endovascular clot retrieval in selected patients managed by an experienced multidisciplinary team. Careful data collection is mandatory.
authors.affiliation: Yorkshire Deanery, UK. Electronic address: carolinebodey@hotmail.co.uk.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bodey
authors.affiliation: Leeds General Infirmary, University of Leeds, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Goddard
authors.affiliation: Leeds General Infirmary, University of Leeds, UK.
authors.forename: Tufail
authors.initials: T
authors.lastname: Patankar
authors.affiliation: Leeds General Infirmary, University of Leeds, UK.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Childs
authors.affiliation: Leeds General Infirmary, University of Leeds, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Ferrie
authors.affiliation: Leeds General Infirmary, University of Leeds, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: McCullagh
authors.affiliation: Leeds General Infirmary, University of Leeds, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Pysden
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D010372:Pediatrics; D012720:Severity of Illness Index; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Arterial ischaemic stroke; Basilar artery stroke; Childhood stroke; Paediatric stroke; Stroke management; Thrombectomy; Thrombolysis