Abstract WP390: Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator in Pediatric Arterial Ischemic Stroke: Lessons From a Case Series

Abstract

Introduction: Stroke is one of the 10 most common causes of death in children. With no randomized studies in children on safety in efficacy, use of tissue plasminogen activator(tPA) and mechanical thrombectomy is limited. Consensus based guidelines are available for the use of thrombolysis in children with arterial ischemic stroke(AIS). Objective: a.) Retrospectively review and analyze patients who had either IV tPA or mechanical thrombectomy or both b.) compare with similar studies Methodology: Study was conducted at Le Bonheur Children’s Hospital in Memphis TN. Data collected as part of International Pediatric Stroke Study, starting from January 2016 until March 2017(15 months) were reviewed retrospectively. Literature review was conducted to compare results. All patients included had at least one follow up after 3 months after the treatment. Results: Out of 38 patients diagnosed to have AIS, four of them (10 %) underwent either tPA or mechanical thrombectomy or both. Age ranged from 14 to 17 years. Pediatric NIH stroke scale on arrival ranged from 6-9. Dose of tPA as well as inclusion and exclusion criteria was based on Thrombolysis in Pediatric Stroke(TIPS) study. All of them had MRI or CT angiogram detection of stroke and arterial occlusion before the procedure. Duration of symptoms to the initiation of one the hyper-acute treatment was 3.5 to 4.5 hours in all except one who underwent thrombectomy for basilar artery thrombosis. One got only tPA thrombolysis, two had both tPA followed by mechanical thrombectomy and the fourth, had basilar artery thrombosis, underwent only thrombectomy with suction as the patient arrived beyond 4.5 hours’ window. No complications were noticed. On follow up after 3 months, 3 out four had full recovery.The fourth patient still had expressive aphasia and cognitive deficits who on MRI head with contrast was found to have persistent enhancement in the cortical area suggestive of vasculitis. Conclusion: In conclusion, 10% of total AIS patients, underwent IV thrombolysis or mechanical thrombectomy and had no complication; similar data was reported in prior studies. However,randomized controlled trials would be necessary to substantiate the validity or reliability of the use of IV tPA or mechanical thrombectomy in pediatric AIS.