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

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.