Successful Mechanical Thrombectomy and Balloon Angioplasty in Two Children With Arterial Ischemic Stroke Caused by Focal Cerebral Arteriopathy

IF 2.1 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2025-07-10 DOI:10.1016/j.pediatrneurol.2025.07.002

Peter B. Sporns MD, MHBA , Flavio Requejo MD

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Abstract

Background

Mechanical thrombectomy (MT), although well established in adults, is gaining acceptance as a viable treatment in pediatric patients, especially with cardioembolic etiology. However, there is an ongoing debate about the use of MT in children with arterial ischemic stroke due to suspected focal cerebral arteriopathy (FCA). Here, we present two cases of pediatric arterial ischemic stroke with high suspicion of FCA successfully treated with MT, highlighting its potential utility in this population. In addition, both cases were treated with balloon angioplasty successfully; thus this report aims to open a discussion on this potential rescue treatment in children with FCA.

Methods

Clinical and imaging diagnosis, technical details of the procedure, and clinical course of the patients with suspected FCA are presented.

Results

Both children presented with M1 occlusions with clinical and imaging features suggesting underlying FCA. After initial thrombectomy, one child had an immediate reocclusion and one presented with residual high-grade stenosis. In both cases, balloon angioplasty of the M1 segment was performed and follow-up imaging confirmed regressive stenosis. Both children had favorable neurological outcomes with a modified Rankin Scale score of 1 at 90 days and one year, respectively.

Conclusion

We describe the successful endovascular treatment of two children with occlusion of the middle cerebral artery due to suspected FCA. In carefully selected and severely affected patients, balloon angioplasty may be an option to secure blood flow distal of the occlusion.

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2例局灶性脑动脉病变所致缺血性脑卒中患儿机械取栓及球囊血管成形术成功

机械取栓术（MT）虽然在成人中已经很成熟，但作为一种可行的治疗方法在儿科患者中也越来越被接受，尤其是在心脏栓塞的病因上。然而，关于MT在疑似局灶性脑动脉病变（FCA）引起的动脉缺血性卒中儿童中的应用仍存在争议。在这里，我们报告了两例小儿动脉缺血性卒中的高怀疑FCA成功治疗MT，突出其在这一人群的潜在效用。两例均成功行球囊血管成形术；因此，本报告旨在就FCA患儿的这种潜在抢救治疗展开讨论。方法对疑似FCA患者的临床、影像学诊断、手术技术细节及临床病程进行分析。结果两例患儿均表现为M1闭塞，临床和影像学特征提示潜在的FCA。最初取栓后，一名儿童立即闭塞，另一名出现残余高度狭窄。两例患者均行M1段球囊成形术，随访影像学证实退行性狭窄。两名儿童在90天和一年时的改良Rankin量表评分分别为1分，神经系统预后良好。结论我们成功地对2例疑似FCA所致的儿童大脑中动脉闭塞进行了血管内治疗。在精心挑选和严重影响的患者，球囊血管成形术可能是一种选择，以确保血流远端闭塞。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.