E-114 Rescue suction mechanical thrombectomy of medium-small vessel occlusion in a pediatric patient presented with acute ischemic stroke. (23rd July 2022)

• Record Type: Journal Article
• Authors: Hart, R; Singh, A; Manzanero, C; Lodi, Y
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A138
• Page End: A139
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.225
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: Endovascular mechanical thrombectomy (MT) has dramatically decreased the mortality and morbidity associated with acute ischemic stroke (AIS) in adults. A similar benefit is seen in pediatric patients, but a due to a lack of documentation in outcomes and lack of universal guidelines on procedures, there are need for greater elucidation of pediatric thrombectomy approach and outcomes. Unfortunately, MT is only performed on large vessel occlusion (LVO). Therefore, AIS with medium and small vessel occlusion (MSVO) with disabling neurological deficit not yet have any clear options. We are presenting a pediatric patient who presented with AIS due to the occlusion of the right anterior cerebral artery (ACA) A2-A3 junction thrombus underwent successful suction MT resulting in complete perfusion and recovery. Methods: Case report: Results: A 17-year-old Caucasian female with a known hypercoagulable state due to 4G/5G PAI-1 activity on Xarelto and history of several previous strokes presented with NIH score of 7 and baseline mRS score of 2. CT angiography was inconclusive, and patient was taken to digital subtraction angiography, which identifying a right A2-A3 junction thrombosis. Procedure: 6 French guiding sheath was placed in the right internal carotid artery. A 3 max intermediate catheter alone with velocity microcatheter and synchro 14 soft microwire were used to reach right ACA A2-A3 junction. Direct suction through the 3 max catheter resulting in TICI 3 revascularization was achieved, and patient improved to NIH score of 4 immediate post operatively. Patient further improved with targeted physical therapy and was discharged home with NIHSS 0 and modified ranking of 2. Direct anticoagulation was switched to warfarin with INR goals of 2–3. Conclusion: Endovascular aspiration mechanical thrombectomy of MSVO is feasible in pediatric patients presenting with AIS and associated with good functional outcome. Additionally, when acute ongoing neurological deficit is present and CTA is inconclusive, a digital subtraction angiography is deemed needed to identify MSVO as the yields of CTA diminishes significantly beyond LVO. Further studies are required. Disclosures: R. Hart: None. A. Singh: None. C. Manzanero: None. Y. Lodi: None.