Mechanical thrombectomy in an 18-month-old infant with acute ischemic stroke with large core infarct and late time window: a case report.

Background: Mechanical thrombectomy (MT) is recognized as the most effective treatment for acute cerebral artery occlusion in adults. However, due to the rarity of acute ischemic stroke (AIS) in children and the lack of robust clinical evidence, the benefits of MT for pediatric patients remain uncertain. This case study aims to provide valuable insights into the treatment considerations for pediatric stroke patients and address various intraoperative and postoperative challenges.

Case description: In this report, we present a case involving an 18-month-old infant who suffered from a stroke. An emergency head magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) performed approximately 30 hours after onset revealed extensive infarction in the left basal ganglia, temporal and parietal lobes, along with occlusion of the left internal carotid artery and middle cerebral artery. Two hours after the imaging examination, the attending pediatrician noted a decline in muscle strength (grade 0) in the right limb and mild drowsiness. Despite the late time window and large core infarction, a thorough clinical and imaging evaluation indicated the presence of salvageable brain tissue. Following MT and subsequent multidisciplinary management, there was a significant reduction in the final infarct volume, preserving brain function. At a 6-month follow-up, the pediatric modified Rankin Scale (mRS) score improved to 1 point, indicating favorable outcomes.

Conclusions: Although our patient has a good prognosis after thrombectomy, surgery should be carefully selected in the face of stroke caused by large vessel occlusion in pediatric patients.