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.