Interventional management of acute ischemic stroke in children

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