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2023

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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ENDOVASCULAR TREATMENT OF ACUTE ISCHEMIC STROKE IN THE PEDIATRIC POPULATION - A SINGLE CENTER EXPERIENCE

TeresaP.Morais1;Isabel Fragata1; Rita Silva2; Ana Paiva Nunes3; João Reis1

1 - Neuroradiology Department, Centro Hospitalar Universitário Lisboa Central, Portugal
2 - Neuropediatry Department, Centro Hospitalar Universitário Lisboa Central, Portugal
3 - Stroke Unit, Centro Hospitalar Universitário Lisboa Central, Portugal

- European Stroke Organization 2019, 23 maio 2019 (poster)

Introduction: Pediatric ischemic stroke is an under-recognized condition, frequently leading to delayed diagnosis. Most childhood strokes are due to intracranial arteriopathy or cardioembolism. Despite strong evidence for endovascular therapy in adults with acute ischemic stroke, limited data exist in children. We aimed to review our center experience with mechanical thrombectomy (MT) in the pediatric population.
Methods: Retrospective review of all cases of MT for acute ischemic stroke in the pediatric population at our center between 2011-2018.
Results: Seven patients (ages between 2-17) with acute ischemic stroke underwent MT for large vessel occlusion (LVO). Most (71%) were female. Cardiac disease was known in 5 (71%) patients - 2 under external cardiac assistance - 1 had Varicella zoster virus vasculopathy - diagnosed a posteriori- and 1 had unknown etiology. The median pedNIHSS at admission was 14 (3-24). All patients had an ASPECTS score>8, except for one with ASPECTS score of 2. Six patients had LVO of the anterior circulation and 1 had a basilar artery occlusion. The median time since onset of symptoms until imaging was 12h30 (1h15min-21h). Aspiration was used in 3 cases (43%); stent retriever in 3 cases (43%) and a combined technique in one case. Complete recanalization (TICI 2C/3) was achieved in 57% of the cases. At 90 days, 2 patients (29%) died and 4 (57%) had a mRS < 2.
Discussion/Conclusion: Mechanical thrombectomy seems safe and feasible in the pediatric population. Multidisciplinary selection of pediatric patients with LVO is warranted. Prospective studies are needed to validate these conclusions.

Keywords: Acute ischemic stroke; endovascular; pediatric; thrombectomy