Abstract
The assessment and interventional management of pediatric arterial ischemic stroke
(AIS) in the acute setting is a challenge, given the lack of safety and efficacy data
on available treatment options and the absence of detailed guidelines specific for
children. Endovascular therapy in pediatric AIS must be considered experimental and
approached cautiously in order to minimize adverse outcomes, as there are no published
studies or prospective clinical trials investigating the safety and efficacy of intra-arterial
thrombolysis or mechanical thrombectomy in the management of pediatric AIS. Additional
complicating factors include typically increased delays and increased challenge to
appropriate diagnosis in children relative to adults, and underlying differences in
the pathophysiology of AIS, the thrombotic cascade, and the natural history of AIS
in children. Judicious extrapolation of adult data might be used for treatment of
these cases with a highly individualized approach at high-volume centers, by a neurointerventional
team in close collaboration with pediatric stroke neurologists. Mechanical approaches
may be a safe and potentially effective therapeutic option.
Keywords
Acute ischemic stroke - children - intra-arterial thrombolysis - thrombectomy - hemorrhagic
conversion
