Mechanical thrombectomy for acute stroke in childhood: how much does restricted diffusion matter?
Mechanical thrombectomy holds promise for children with large cerebral arterial occlusions, although there are few reports in this population. We report a case of retrievable stent-assisted mechanical thrombectomy in a 5-year-old with basilar artery occlusion, despite late presentation and extensive initial diffusion-weighted imaging (DWI) restriction. This resulted in successful Thrombolysis in Cerebral Infarction 2B reperfusion and excellent clinical outcome. At 6-week follow-up he was completely back to baseline with no residual deficits (pediatric stroke outcome measure=0, modified Rankin scale=0). At 3-month follow-up the patient has not had any recurrent stroke or concern for stroke-like symptoms. We review the literature on mechanical thrombectomy and DWI changes in acute stroke in early to middle childhood (<12 years old).
Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA.
Travis R
TR
Ladner
Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA.
Lucy
L
He
Division of Neurology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.
Lori C
LC
Jordan
Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA.
Calvin
C
Cooper
Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Michael T
MT
Froehler
Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA.
J
J
Mocco
D001488:Basilar Artery / Q000473:pathology; D001921:Brain / Q000473:pathology*; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D061185:Mechanical Thrombolysis; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000628:therapy*
Dissection; MRI; Pediatrics; Stroke; Thrombectomy