Abstract 56: Incidence of Large Vessel Occlusions in Children Who Present Within Extended Thrombectomy Treatment Window

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Introduction: Mechanical thrombectomy (MT) should be considered in children with persistent deficits with large vessel occlusion (LVO), although the recognition and diagnosis of stroke is often delayed. With the recent extension of treatment windows to 24 hours in adult studies, more children may now be MT candidates. The aim of this project was to examine LVO incidence in childhood strokes that present within 24 hours of symptom onset. Methods: Patients with clinical and radiographic confirmed stroke from 1995-2018 were identified via internal database search. Patients with last known normal < 24 hours and imaging within the MT time window (24 hours) were included for analysis. A pediatric neuroradiologist independently reviewed imaging to confirm presence/absence of LVO. Results: Of 165 patients with childhood stroke, 60 (36.3%) had last known normal <24 hours and vessel imaging within the MT timeframe (table). Fourteen patients (8.5%) had an LVO; nine with internal carotid or M1 and five with M2 occlusions. Median time from symptom onset to imaging was 6.47 hours in LVO patients. Most common stroke etiologies with LVO were unilateral focal cerebral arteriopathy of childhood (5) and other (5). One of the LVO patients underwent MT. Conclusions: At our institution, over 1/3 rd of patients presented within 24 hour of symptom onset with vascular imaging, and nearly 1/4 of those children (8.5% overall) had an LVO amenable to potential MT. While not all children with LVO will be MT candidates, this study shows that significant numbers of children present with LVO within the adult MT treatment window.