Endovascular thrombectomy in pediatric patients with large vessel occlusion

Hazem Shoirah, Hussain Shallwani, Adnan H. Siddiqui, Elad I. Levy, Cynthia L. Kenmuir, Tudor G. Jovin, Michael R. Levitt, Louis J. Kim, Julius Griauzde, Aditya S. Pandey, Joseph J. Gemmete, Todd Abruzzo, Adam Arthur, Lucas Elijovich, Daniel Hoit, Ahmed Cheema, Amin Aghaebrahim, Eric Sauvageau, Ricardo Hanel, Andrew J. Ringer & 3 others Fábio A. Nascimento, Peter Kan, J. Mocco

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Abstract

Background Pediatric acute ischemic stroke with underlying large vessel occlusion is a rare disease with significant morbidity and mortality. There is a paucity of data about the safety and outcomes of endovascular thrombectomy in these cases, especially with modern devices. Methods We conducted a retrospective review of all pediatric stroke patients who underwent endovascular thrombectomy in nine US tertiary centers between 2008 and 2017. Results Nineteen patients (63.2% male) with a mean (SD) age of 10.9(6) years and weight 44.6 (30.8) kg were included. Mean (SD) NIH Stroke Scale (NIHSS) score at presentation was 13.9 (5.7). CT-based assessment was obtained in 88.2% of the patients and 58.8% of the patients had perfusion-based assessment. All procedures were performed via the transfemoral approach. The first-pass device was stentriever in 52.6% of cases and aspiration in 36.8%. Successful revascularization was achieved in 89.5% of the patients after a mean (SD) of 2.2 (1.5) passes, with a mean (SD) groin puncture to recanalization time of 48.7 (37.3) min (median 41.5). The mean (SD) reduction in NIHSS from admission to discharge was 10.2 (6.2). A good neurological outcome was achieved in 89.5% of the patients. One patient had post-revascularization seizure, but no other procedural complications or mortality occurred. Conclusions Endovascular thrombectomy is safe and feasible in selected pediatric patients. Technical and neurological outcomes were comparable to adult literature with no safety concerns with the use of standard adult devices in patients as young as 18 months. This large series adds to the growing literature but further studies are warranted.

Original languageEnglish (US)
Pages (from-to)729-732
Number of pages4
JournalJournal of neurointerventional surgery
Volume11
Issue number7
DOIs
StatePublished - Jul 1 2019

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Thrombectomy
Pediatrics
Stroke
Equipment and Supplies
Safety
Mortality
Groin
Rare Diseases
Punctures
Seizures
Perfusion
Morbidity
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Shoirah, H., Shallwani, H., Siddiqui, A. H., Levy, E. I., Kenmuir, C. L., Jovin, T. G., ... Mocco, J. (2019). Endovascular thrombectomy in pediatric patients with large vessel occlusion. Journal of neurointerventional surgery, 11(7), 729-732. https://doi.org/10.1136/neurintsurg-2018-014320

Endovascular thrombectomy in pediatric patients with large vessel occlusion. / Shoirah, Hazem; Shallwani, Hussain; Siddiqui, Adnan H.; Levy, Elad I.; Kenmuir, Cynthia L.; Jovin, Tudor G.; Levitt, Michael R.; Kim, Louis J.; Griauzde, Julius; Pandey, Aditya S.; Gemmete, Joseph J.; Abruzzo, Todd; Arthur, Adam; Elijovich, Lucas; Hoit, Daniel; Cheema, Ahmed; Aghaebrahim, Amin; Sauvageau, Eric; Hanel, Ricardo; Ringer, Andrew J.; Nascimento, Fábio A.; Kan, Peter; Mocco, J.

In: Journal of neurointerventional surgery, Vol. 11, No. 7, 01.07.2019, p. 729-732.

Research output: Contribution to journalArticle

Shoirah, H, Shallwani, H, Siddiqui, AH, Levy, EI, Kenmuir, CL, Jovin, TG, Levitt, MR, Kim, LJ, Griauzde, J, Pandey, AS, Gemmete, JJ, Abruzzo, T, Arthur, A, Elijovich, L, Hoit, D, Cheema, A, Aghaebrahim, A, Sauvageau, E, Hanel, R, Ringer, AJ, Nascimento, FA, Kan, P & Mocco, J 2019, 'Endovascular thrombectomy in pediatric patients with large vessel occlusion', Journal of neurointerventional surgery, vol. 11, no. 7, pp. 729-732. https://doi.org/10.1136/neurintsurg-2018-014320
Shoirah, Hazem ; Shallwani, Hussain ; Siddiqui, Adnan H. ; Levy, Elad I. ; Kenmuir, Cynthia L. ; Jovin, Tudor G. ; Levitt, Michael R. ; Kim, Louis J. ; Griauzde, Julius ; Pandey, Aditya S. ; Gemmete, Joseph J. ; Abruzzo, Todd ; Arthur, Adam ; Elijovich, Lucas ; Hoit, Daniel ; Cheema, Ahmed ; Aghaebrahim, Amin ; Sauvageau, Eric ; Hanel, Ricardo ; Ringer, Andrew J. ; Nascimento, Fábio A. ; Kan, Peter ; Mocco, J. / Endovascular thrombectomy in pediatric patients with large vessel occlusion. In: Journal of neurointerventional surgery. 2019 ; Vol. 11, No. 7. pp. 729-732.
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abstract = "Background Pediatric acute ischemic stroke with underlying large vessel occlusion is a rare disease with significant morbidity and mortality. There is a paucity of data about the safety and outcomes of endovascular thrombectomy in these cases, especially with modern devices. Methods We conducted a retrospective review of all pediatric stroke patients who underwent endovascular thrombectomy in nine US tertiary centers between 2008 and 2017. Results Nineteen patients (63.2{\%} male) with a mean (SD) age of 10.9(6) years and weight 44.6 (30.8) kg were included. Mean (SD) NIH Stroke Scale (NIHSS) score at presentation was 13.9 (5.7). CT-based assessment was obtained in 88.2{\%} of the patients and 58.8{\%} of the patients had perfusion-based assessment. All procedures were performed via the transfemoral approach. The first-pass device was stentriever in 52.6{\%} of cases and aspiration in 36.8{\%}. Successful revascularization was achieved in 89.5{\%} of the patients after a mean (SD) of 2.2 (1.5) passes, with a mean (SD) groin puncture to recanalization time of 48.7 (37.3) min (median 41.5). The mean (SD) reduction in NIHSS from admission to discharge was 10.2 (6.2). A good neurological outcome was achieved in 89.5{\%} of the patients. One patient had post-revascularization seizure, but no other procedural complications or mortality occurred. Conclusions Endovascular thrombectomy is safe and feasible in selected pediatric patients. Technical and neurological outcomes were comparable to adult literature with no safety concerns with the use of standard adult devices in patients as young as 18 months. This large series adds to the growing literature but further studies are warranted.",
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T1 - Endovascular thrombectomy in pediatric patients with large vessel occlusion

AU - Shoirah, Hazem

AU - Shallwani, Hussain

AU - Siddiqui, Adnan H.

AU - Levy, Elad I.

AU - Kenmuir, Cynthia L.

AU - Jovin, Tudor G.

AU - Levitt, Michael R.

AU - Kim, Louis J.

AU - Griauzde, Julius

AU - Pandey, Aditya S.

AU - Gemmete, Joseph J.

AU - Abruzzo, Todd

AU - Arthur, Adam

AU - Elijovich, Lucas

AU - Hoit, Daniel

AU - Cheema, Ahmed

AU - Aghaebrahim, Amin

AU - Sauvageau, Eric

AU - Hanel, Ricardo

AU - Ringer, Andrew J.

AU - Nascimento, Fábio A.

AU - Kan, Peter

AU - Mocco, J.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background Pediatric acute ischemic stroke with underlying large vessel occlusion is a rare disease with significant morbidity and mortality. There is a paucity of data about the safety and outcomes of endovascular thrombectomy in these cases, especially with modern devices. Methods We conducted a retrospective review of all pediatric stroke patients who underwent endovascular thrombectomy in nine US tertiary centers between 2008 and 2017. Results Nineteen patients (63.2% male) with a mean (SD) age of 10.9(6) years and weight 44.6 (30.8) kg were included. Mean (SD) NIH Stroke Scale (NIHSS) score at presentation was 13.9 (5.7). CT-based assessment was obtained in 88.2% of the patients and 58.8% of the patients had perfusion-based assessment. All procedures were performed via the transfemoral approach. The first-pass device was stentriever in 52.6% of cases and aspiration in 36.8%. Successful revascularization was achieved in 89.5% of the patients after a mean (SD) of 2.2 (1.5) passes, with a mean (SD) groin puncture to recanalization time of 48.7 (37.3) min (median 41.5). The mean (SD) reduction in NIHSS from admission to discharge was 10.2 (6.2). A good neurological outcome was achieved in 89.5% of the patients. One patient had post-revascularization seizure, but no other procedural complications or mortality occurred. Conclusions Endovascular thrombectomy is safe and feasible in selected pediatric patients. Technical and neurological outcomes were comparable to adult literature with no safety concerns with the use of standard adult devices in patients as young as 18 months. This large series adds to the growing literature but further studies are warranted.

AB - Background Pediatric acute ischemic stroke with underlying large vessel occlusion is a rare disease with significant morbidity and mortality. There is a paucity of data about the safety and outcomes of endovascular thrombectomy in these cases, especially with modern devices. Methods We conducted a retrospective review of all pediatric stroke patients who underwent endovascular thrombectomy in nine US tertiary centers between 2008 and 2017. Results Nineteen patients (63.2% male) with a mean (SD) age of 10.9(6) years and weight 44.6 (30.8) kg were included. Mean (SD) NIH Stroke Scale (NIHSS) score at presentation was 13.9 (5.7). CT-based assessment was obtained in 88.2% of the patients and 58.8% of the patients had perfusion-based assessment. All procedures were performed via the transfemoral approach. The first-pass device was stentriever in 52.6% of cases and aspiration in 36.8%. Successful revascularization was achieved in 89.5% of the patients after a mean (SD) of 2.2 (1.5) passes, with a mean (SD) groin puncture to recanalization time of 48.7 (37.3) min (median 41.5). The mean (SD) reduction in NIHSS from admission to discharge was 10.2 (6.2). A good neurological outcome was achieved in 89.5% of the patients. One patient had post-revascularization seizure, but no other procedural complications or mortality occurred. Conclusions Endovascular thrombectomy is safe and feasible in selected pediatric patients. Technical and neurological outcomes were comparable to adult literature with no safety concerns with the use of standard adult devices in patients as young as 18 months. This large series adds to the growing literature but further studies are warranted.

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