Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature
Autor(a) principal: | |
---|---|
Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/4051 |
Resumo: | Introduction: Mechanical thrombectomy is standard treatment for large vessel occlusion (LVO) in adults. There are no randomized controlled trials for the pediatric population. We report our single-center experience with thrombectomy of LVO in a series of pediatric patients, and perform a review of the literature. Methods: Retrospective review of consecutive pediatric thrombectomy cases between 2011 and 2018. Demographic variables, imaging data, technical aspects and clinical outcome were recorded. Results: In a period of 7 years, 7 children were treated for LVO at our center. Median age was 13 (2-17), and median Ped-NIHSS was 15 (3-24), and the median ASPECTS was 8 (2-10). Five patients had cardiac disease, and 2 of them were under external cardiac assistance. Median time from onset of symptoms to beginning of treatment was 7h06m (2h58m-21h38m). Five patients had middle cerebral artery occlusions. Thrombectomy was performed using a stentriever in 3 patients, aspiration in 3 patients, and combined technique in 1 patient. Six patients had good recanalization (TICI 2 b/3). There were no immediate periprocedural complications. At 3 months, 4 patients (57%) were independent (mRS score <3). Two patients died, one after haemorrhagic transformation of an extensive MCA infarct, and one due to extensive brainstem ischemia in the setting of varicella vasculitis. Discussion: Selected pediatric patients with LVO may be treated with mechanical thrombectomy safely. In patients under external cardiac assistance and under anticoagulation, thrombectomy is the only alternative for treatment of LVO. A multidisciplinary approach in specialized pediatric stroke centers with trained neurointerventionalists are essential for good results. |
id |
RCAP_fdb7945a69a8c599c3d62cb93889ca56 |
---|---|
oai_identifier_str |
oai:repositorio.chlc.min-saude.pt:10400.17/4051 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the LiteratureCHLC NRADHDE NEU PEDCHLC NEUHSM CAR PEDAdolescentChildHumansAdultBrain Ischemia* / diagnostic imagingBrain Ischemia* / surgeryIschemic Stroke*Retrospective StudiesTreatment OutcomeStroke* / diagnostic imagingStroke* / surgeryThrombectomyIntroduction: Mechanical thrombectomy is standard treatment for large vessel occlusion (LVO) in adults. There are no randomized controlled trials for the pediatric population. We report our single-center experience with thrombectomy of LVO in a series of pediatric patients, and perform a review of the literature. Methods: Retrospective review of consecutive pediatric thrombectomy cases between 2011 and 2018. Demographic variables, imaging data, technical aspects and clinical outcome were recorded. Results: In a period of 7 years, 7 children were treated for LVO at our center. Median age was 13 (2-17), and median Ped-NIHSS was 15 (3-24), and the median ASPECTS was 8 (2-10). Five patients had cardiac disease, and 2 of them were under external cardiac assistance. Median time from onset of symptoms to beginning of treatment was 7h06m (2h58m-21h38m). Five patients had middle cerebral artery occlusions. Thrombectomy was performed using a stentriever in 3 patients, aspiration in 3 patients, and combined technique in 1 patient. Six patients had good recanalization (TICI 2 b/3). There were no immediate periprocedural complications. At 3 months, 4 patients (57%) were independent (mRS score <3). Two patients died, one after haemorrhagic transformation of an extensive MCA infarct, and one due to extensive brainstem ischemia in the setting of varicella vasculitis. Discussion: Selected pediatric patients with LVO may be treated with mechanical thrombectomy safely. In patients under external cardiac assistance and under anticoagulation, thrombectomy is the only alternative for treatment of LVO. A multidisciplinary approach in specialized pediatric stroke centers with trained neurointerventionalists are essential for good results.SageRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEFragata, IMorais, TSilva, RPaiva Nunes, ALoureiro, PMartins, JDPamplona, JCarvalho, RBaptista, MReis, J2022-04-28T14:46:10Z20212021-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/4051engInterv Neuroradiol. 2021 Feb;27(1):16-24.10.1177/1591019920958827.info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:45:04Zoai:repositorio.chlc.min-saude.pt:10400.17/4051Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:21:21.628259Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature |
title |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature |
spellingShingle |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature Fragata, I CHLC NRAD HDE NEU PED CHLC NEU HSM CAR PED Adolescent Child Humans Adult Brain Ischemia* / diagnostic imaging Brain Ischemia* / surgery Ischemic Stroke* Retrospective Studies Treatment Outcome Stroke* / diagnostic imaging Stroke* / surgery Thrombectomy |
title_short |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature |
title_full |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature |
title_fullStr |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature |
title_full_unstemmed |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature |
title_sort |
Endovascular Treatment of Pediatric Ischemic Stroke: a Single Center Experience and Review of the Literature |
author |
Fragata, I |
author_facet |
Fragata, I Morais, T Silva, R Paiva Nunes, A Loureiro, P Martins, JD Pamplona, J Carvalho, R Baptista, M Reis, J |
author_role |
author |
author2 |
Morais, T Silva, R Paiva Nunes, A Loureiro, P Martins, JD Pamplona, J Carvalho, R Baptista, M Reis, J |
author2_role |
author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Fragata, I Morais, T Silva, R Paiva Nunes, A Loureiro, P Martins, JD Pamplona, J Carvalho, R Baptista, M Reis, J |
dc.subject.por.fl_str_mv |
CHLC NRAD HDE NEU PED CHLC NEU HSM CAR PED Adolescent Child Humans Adult Brain Ischemia* / diagnostic imaging Brain Ischemia* / surgery Ischemic Stroke* Retrospective Studies Treatment Outcome Stroke* / diagnostic imaging Stroke* / surgery Thrombectomy |
topic |
CHLC NRAD HDE NEU PED CHLC NEU HSM CAR PED Adolescent Child Humans Adult Brain Ischemia* / diagnostic imaging Brain Ischemia* / surgery Ischemic Stroke* Retrospective Studies Treatment Outcome Stroke* / diagnostic imaging Stroke* / surgery Thrombectomy |
description |
Introduction: Mechanical thrombectomy is standard treatment for large vessel occlusion (LVO) in adults. There are no randomized controlled trials for the pediatric population. We report our single-center experience with thrombectomy of LVO in a series of pediatric patients, and perform a review of the literature. Methods: Retrospective review of consecutive pediatric thrombectomy cases between 2011 and 2018. Demographic variables, imaging data, technical aspects and clinical outcome were recorded. Results: In a period of 7 years, 7 children were treated for LVO at our center. Median age was 13 (2-17), and median Ped-NIHSS was 15 (3-24), and the median ASPECTS was 8 (2-10). Five patients had cardiac disease, and 2 of them were under external cardiac assistance. Median time from onset of symptoms to beginning of treatment was 7h06m (2h58m-21h38m). Five patients had middle cerebral artery occlusions. Thrombectomy was performed using a stentriever in 3 patients, aspiration in 3 patients, and combined technique in 1 patient. Six patients had good recanalization (TICI 2 b/3). There were no immediate periprocedural complications. At 3 months, 4 patients (57%) were independent (mRS score <3). Two patients died, one after haemorrhagic transformation of an extensive MCA infarct, and one due to extensive brainstem ischemia in the setting of varicella vasculitis. Discussion: Selected pediatric patients with LVO may be treated with mechanical thrombectomy safely. In patients under external cardiac assistance and under anticoagulation, thrombectomy is the only alternative for treatment of LVO. A multidisciplinary approach in specialized pediatric stroke centers with trained neurointerventionalists are essential for good results. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021 2021-01-01T00:00:00Z 2022-04-28T14:46:10Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/4051 |
url |
http://hdl.handle.net/10400.17/4051 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Interv Neuroradiol. 2021 Feb;27(1):16-24. 10.1177/1591019920958827. |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sage |
publisher.none.fl_str_mv |
Sage |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799131309332758528 |