Abstract Body: Introduction: Mechanical thrombectomy (MT) is increasingly being performed in children with stroke due to large and medium vessel occlusion (LVO and MeVO). While retrospective series suggest favorable outcomes after MT, selection criteria for the pediatric population have not been defined. We aimed to analyze characteristics of children with LVO and MeVO and describe reasons for not pursing MT in children with acute vascular occlusion.
Methods: The Stanford Pediatric Stroke Registry retrospectively enrolled pediatric patients with acute arterial ischemic stroke (AIS) admitted to our tertiary care center between 2007-2024. For this analysis, we included patients age 29 days-21 years with acute neuroimaging and clinical documentation available for direct review. LVO was defined as occlusion of the extra-/intracranial Internal Carotid Artery (eICA/iICA), Middle Cerebral Artery (MCA)-M1, Anterior Cerebral Artery (ACA)-A1, vertebral artery (VA) or basilar artery (BA). MeVO was defined as occlusion of the MCA-M2, MCA-M3 or ACA-A2. Patient charts were reviewed for documentation of medical decision-making, and reasons for forgoing MT were assigned by two pediatric neurologists trained in stroke (SL) and neurocritical care (EM). Clinical and imaging characteristics were compared using chi-squared or Fishers Exact test for categorical variables and Mann-Whitney U test or t-test for continuous variables. Results were reported using descriptive statistics.
Results: Among 208 children with acute AIS, 82 (39.4%) had LVO/MeVO (Figure 1); 14 children had multiple occlusions for a total of 114 vascular occlusions (90 LVO, 24 MeVO). Patients with LVO/MeVO were older, had higher NIHSS and more often underwent contrast perfusion imaging compared to non-LVO/MeVO patients (Table 1). Among LVO/MeVO patients, Moyamoya Arteriopathy (MMA) was the final diagnosis in 10 (5 with a pre-existing diagnosis). Excluding those, 72 patients (34.6%) had a non-MMA vascular occlusion. MT was performed in 18 patients; of the 64 who did not undergo MT, the most common primary reasons intervention was not pursued were 1) concern for arteriopathy or infection (n=15) and 2) completed/large infarct burden (n=14, Figure 2).
Conclusions: LVO/MeVO is not uncommon in children. In our cohort, LVO/MeVO was diagnosed in over 1/3 of children with acute AIS, and a quarter of those underwent MT. Further multicenter prospective studies are needed to define MT selection criteria in this unique population.