title: Thrombectomy for Acute Stroke in Childhood: A Case Report, Literature Review, and Recommendations.
abstract: The updated American Heart Association/American Stroke Association guidelines include recommendation for thrombectomy in certain adult stroke cases. The safety and efficacy of thrombectomy in children are unknown. An 8-year-old girl experienced acute stroke symptoms on two occasions while therapeutically anticoagulated on Novalung. Computed tomography scans showed proximal vessel thrombi, which were retrieved using a Trevo device without hemorrhagic complications. Postprocedural assessment found respective decreases in the National Institutes of Health Stroke Scale score from 10 to 4 and 12 to 7. The indications for treatment and early benefits observed in our case are consistent with other pediatric thrombectomy cases reported. However, publication bias and the heterogeneity of reported cases prevent drawing conclusions about the safety and efficacy of thrombectomy in children. Anticipating that updates to adult stroke guidelines would likely incite stroke providers to consider thrombectomy in children, our institution developed guidelines for thrombectomy before the index patient. Establishing institutional guidelines before considering thrombectomy in children may optimize patient safety.
authors: Division of Neurology, Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Maria Celeste
authors: MC
authors: Buompadre
authors: Division of Neurology, Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Kathleen
authors: K
authors: Andres
authors: Department of Medical Imaging, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Surgery, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
authors: Lee-Anne
authors: LA
authors: Slater
authors: Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Hadi
authors: H
authors: Mohseni-Bod
authors: Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Anne-Marie
authors: AM
authors: Guerguerian
authors: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Helen
authors: H
authors: Branson
authors: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Suzanne
authors: S
authors: Laughlin
authors: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Derek
authors: D
authors: Armstrong
authors: Division of Neurology, Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Mahendranath
authors: M
authors: Moharir
authors: Division of Neurology, Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Gabrielle
authors: G
authors: deVeber
authors: Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Tilman
authors: T
authors: Humpl
authors: Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Osami
authors: O
authors: Honjo
authors: Division of Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Shaf
authors: S
authors: Keshavjee
authors: Division of Neurology, The Children Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Rebecca
authors: R
authors: Ichord
authors: Department of Medical Imaging, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Surgery, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
authors: Vitor
authors: V
authors: Pereira
authors: Division of Neurology, Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: nomazulu.dlamini@sickkids.ca.
authors: Nomazulu
authors: N
authors: Dlamini
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D017131:Thrombectomy
keywords: embolectomy; endovascular procedures; interventional lung-assist device; mechanical thrombectomy; oxygenators; pediatric stroke; stroke; treatment