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Magnetic resonance angiography (MRI) of vessel in the brain

A new framework helps guide safe pediatric diagnostic cerebral angiography

Magnetic resonance angiography (MRI) of vessel in the brain

Although many practitioners perform cerebral angiograms in children, these practitioners have varying levels of prior neuroangiography training and experience.

The Society of Neurointerventional Surgery (SNIS) Pediatric Committee published practice guidelines for pediatric diagnostic cerebral angiography (DCA) in a recent report. Monica Pearl, M.D., director of Neurointerventional Radiology Program at Children’s National Hospital, and other experts developed a framework within the report to ensure that DCA is performed safely in children. The findings detailed specific procedural considerations as well as peri-procedural evaluation and care.

“Diagnostic cerebral angiography has a low complication rate and maintaining this safety profile in children is an expectation for all practitioners performing this procedure,” Dr. Pearl said. “This is predicated on supplementing prior training and experience with a sustained, consistent volume of pediatric cases while paying special attention to the important nuances described in the findings.”

Although many practitioners perform cerebral angiograms in children, these practitioners have varying levels of prior neuroangiography training and experience. Dr. Pearl and experts suggest that a consistent volume of pediatric cases, modifications in device sizes, medication dosing, radiation protocols and technique are necessary to maintain the expected favorable safety profile. The recommendations also include referral to a higher-volume pediatric center or practitioner for those operators who infrequently perform cerebral angiography in children.

“Patient families and referring providers should seek practitioners with ample pediatric neuroangiography experience,” Dr. Pearl advised. “We provide this level of care and experience here at Children’s National.”

As the senior author for this paper, Dr. Pearl led this effort and shaped the task force recommendations providing critical input based on her current and prior pediatric neuroangiography experience. She and her team continue to serve as the leading advocates for the safety of cerebral neuroangiography procedures in children.

Blood Clot or thrombus

Endovascular therapy for acute stroke in children

Blood Clot or thrombus

Endovascular therapies for acute childhood stroke remain controversial and little evidence exists to determine the minimum age and size cut-off for thrombectomy in children. In a recent study published in the Journal of NeuroInterventional Surgery, Monica S. Pearl, M.D., director of Neurointerventional Radiology Program at Children’s National Hospital, and other experts found an increasing number of reports suggesting the feasibility of thrombectomy in at least some children by experienced operators.

When compared with adults, technical modifications may be necessary in children owing to differences in vessel sizes, tolerance of blood loss, safety of contrast and radiation exposure, and differing stroke etiologies. Dr. Pearl and experts reviewed critical considerations for neurologists and neurointerventionalists when treating pediatric stroke with endovascular therapies.

Additional study authors from Children’s National include: Dana Harrar, M.D., Ph.D., and Carlos Castillo Pinto, M.D., F.A.A.P.

Read the full study in the Journal of NeuroInterventional Surgery.

Artificial Intelligence concept image

Thrombectomy can be efficient and safe in childhood stroke, new study finds

Artificial Intelligence concept image

A recent study adds to the growing evidence that mechanical thrombectomy can be effective and safe not only in adults, but also in childhood stroke.

Previous randomized trials proved the effectiveness of thrombectomy for large intracranial vessel occlusions in adults only. However, a recent retrospective study led by Monica S. Pearl, M.D., Neurointerventional Radiology Program director at Children’s National Hospital, finds that thrombectomy can be safely performed in carefully selected cases of childhood stroke. The study further shows that treated children have good neurological outcomes.

In the findings, Dr. Pearl and other leading experts discussed specific circumstances and important considerations to take into account when managing a child with acute ischemic stroke due to a large vessel occlusion.

“We are raising the bar for the expected level of care for children with acute ischemic stroke,” said Dr. Pearl. “Care should be multidisciplinary and involve stroke neurology, neuroradiology, neurointerventional radiology, neurosurgery, cardiology, hematology and ICU teams.”

Prior to the study, clear guidelines for patient selection, thrombectomy technique and periprocedural care did not exist for the pediatric population despite the proven success of mechanical thrombectomy in adults.

Through a case-based approach encompassing a broad range of ages and clinical presentations, Dr. Pearl and other leading experts presented select cases of acute ischemic stroke in children and discussed the nuances, risks, benefits and management plan for each child.

Many of the clinical scenarios highlighted unanswered questions in the management and treatment of children with acute ischemic stroke due to large vessel occlusion. The study adds to the growing evidence that mechanical thrombectomy can be effective and safe not only in adults, but also in childhood stroke.

“It’s exciting to be shaping management for children with acute ischemic stroke,” said Dr. Pearl. “We are serving as the model for individualized, patient-centered care with multidisciplinary specialists and institutional collaboration caring for children with acute ischemic stroke.”

However, Dr. Pearl and experts encourage caution because etiology in childhood stroke differs substantially from that in acute ischemic stroke in adults, with potentially major impact on procedure success and safety.

The mission of the Neurointerventional Radiology Program, a new effort at Children’s National, is to provide exceptional family-centered care and cutting-edge diagnostic and endovascular treatment options for children with neurovascular disorders. Dr. Pearl serves as the program’s full time, dedicated neurointerventional radiologist, a specialized expertise found only in a handful of other pediatric hospitals in the country.

You can find the full study published in JAHA. Learn more about the Children’s National Research Institute Center for Neuroscience Research.