E-088 successful mechanical thrombectomy for basilar artery stroke in a 22-month old child

Abstract

Stroke is a leading cause of morbidity and mortality. 70% of children with acute ischemic stroke will survive with disability. The use of intra-arterial thrombectomy has recently been shown to have benefit in adults with acute large vessel occlusion. There are no randomized trials to guide treatment of acute stroke in children. We present the case of a 22-month-old with basilar artery occlusion successfully treated with mechanical thrombectomy. The patient presented to the emergency department with altered mental status and gait ataxia. She “felt limp”, her breathing was shallow, and her gaze dysconjugate. Her medical history included congenital heart defects with multiple cardiac procedures. In the emergency department, she fell with attempted ambulation. Labs were normal, as was a chest x-ray, and EKG. A computerized tomography (CT) scan of the head suggested left cerebellar hemisphere attenuation. The differential included arrhythmia, stroke, or seizures. An MRI demonstrated foci of restricted diffusion in the brainstem. The MRA was notable for a lack of opacification of the mid- and distal basilar artery. Angiography and mechanical thrombectomy were recommended. The patient was in the angiography suite 16 h and 12 min after ictus. A baseline angiogram confirmed the basilar artery occlusion. A 6-French Cello balloon guide was placed into the distal V2 segment of the left vertebral artery. The Solitaire 4 × 20 mm stentriever was placed in the target vessel for five minutes and then removed under flow arrest and aspiration. Demonstrable revascularization (TICI 2b) was seen, along with severe vasospasm in the basilar and left vertebral artery. Chemical angioplasty was performed with 5mg of intra-arterial nicardipine. This resulted in significant improvement, with TICI 3 revascularization. The patient was transferred to the PICU. She was extubated on POD #1 and discharged home on POD # 10. Her NIHSS was 0 at six-months post-stroke. Disclosures C. Roark: None. L. Savastano: None. D. Wilkinson: None. R. Shastri: None. V. Vadlamudi: None. N. Chaudhary: None. A. Pandey: None. J. Gemmete: None.