Article Figures & Data
Figures
- Figure 1
An area of restricted diffusion was seen in the basal ganglia on the left (A) with confirmation of the suspected carotid T-occlusion seen on catheter angiography (B, C). After a single pass with a pREset 4×20 mm stent retriever there was complete recanalisation of the left M1 with only a single opercular branch still occluded (thrombolysis in cerebral infarction (TICI) 2b) (D). The procedure was terminated at this point. An MRI scan performed at 24 hours (E) showed an infarction within the left basal ganglia.
- Figure 2
An MRI demonstrated hyperintense signal within the M2 and M3 branches of the left middle cerebral artery (MCA) consistent with slow flow (A). Angiography demonstrated an acute occlusion of the left terminal M1 segment (B). After an initial aspiration thrombectomy attempt the M1 segment was recanalised, however, further thrombus was seen in the M2 branches and therefore further stent retriever mechanical thrombectomy was performed using a Solitaire 4×20 mm resulting in thrombolysis in cerebral infarction (TICI) 2b recanalisation (C).
Tables
- Table 1
Summary of the presenting NIHSS, imaging findings, relevant timings and 90-day mRS
Patient No Demographics NIHSS Imaging Timing mRS Age Gender Modality Clot location ASPECTS Duration of treatment Time to recanalisation 1 17 F 9 CT and MRI+TOF Left carotid T 7 128 445 2 2 11 F 2 MRI+TOF Left M1 9 49 354 0 3 16 M 15 CT+CTA Left M1 7 104 242 2 4 7 M 7 MRI+TOF Left V4 segment NA 56 NA 1 5 15 F 23 MRI+TOF Left carotid T 8 21 290 0 ASPECTS, Alberta Stroke Program Early CT Score; CTA, CT angiogram; mRS, modified Rankin Scale; NA, not applicable; NIHSS, National Institutes of Health Stroke Scale; TOF, time-of-flight.
- Table 2
A summary of the equipment used in each case
Patient No Access Sheath Guide catheter Distal access catheter Flow reversal Microcatheter Stent retriever/aspiration catheter/other Complications 1 Right CFA 8Fr short sheath 8Fr Vista Brite Tip 5Fr Sofia Yes—manual Velocity 4×20 mm pREset, 3×20 mm pREset LT N 2 Right CFA 8Fr short sheath 8Fr Guider Softip ReFlex Yes—manual Prowler Select Plus 3×30 mm Solitaire N 3 Right CFA 8Fr short sheath 8Fr Guider Softip ReFlex Yes—manual Prowler Select Plus 3×30 mm Solitaire N 4 Right CFA 6Fr short sheath 6Fr Envoy NA Yes—manual Prowler Select Plus No—Alligator N 5 Right CFA 8Fr short sheath 8Fr Guider Softip ACE 68 Yes—manual NA ACE 68 N CFA, common femoral artery; NA, not applicable.
- Table 3
Summary of the published mechanical thrombectomy cases performed in the paediatric age group
Authors Age Sex NIHSS Thrombus location Treatment device Flow restoration Clinical outcome Vega et al 44 11 M 16 R M1 segment of MCA Trevo stent+Penumbra Y—TICI 2 c NIHSS 7, 9 days post-op Huded et al 45 6 M 15 Both vertebral arteries+basilar artery Solitaire stent Y—TICI 2 c/3 NIHSS 0 at discharge, non-ambulatory at 3 months Savastano et al 46 22 months F NA Basilar artery Solitaire stent Y—TICI 3 Neurologically intact Stidd and Lopes47 2 M NA R M1 segment of MCA Trevo Y—TICI 2b Improvement in hemiplegia, mild deficit in left hand and facial droop at 30 days Ladner et al 48 5 M 22 Basilar artery Solitaire stent Y—TICI 2b NIHSS 0 at 6 weeks Sainz de la Maza et al 49 12 F 18 R M1 segment of MCA Solitaire stent Y—TICI 2 c NIHSS 1 at 3 months Bodey et al 40 10 M 27 Basilar artery Revive Y—TICI 3 Left hemiparesis and impaired cognition at 6 months, mRS 3 5 M 29 Basilar artery Solitaire stent Y—TICI 3 Ataxia at 6 months, mRS 2 6 M 28 Basilar artery Solitaire stent Y—TICI 2b No motor deficit, mRS 0 15 M 21 L MCA Solitaire stent NA—TICI 3? No deficit, mRS 0 at 6 months Dubedout et al 50 7 M 20 Basilar artery Capture stent Y—TICI 3 NIHSS 0 at discharge Fink et al 51 11 6 Basilar artery Solitaire Y—TICI 3 Slight dysarthria at 3 months Xavier et al 52 16 11 R ICA Penumbra+Wingspan stent NA NIHSS 1 at 3 months Huded et al 45 7 M 17 R ICA Solitaire stent+Penumbra Y—TICI 2a NIHSS 2 at 3 months 9 F 17 L ICA Solitaire stent+Penumbra Y—TICI 2b NIHSS 1 at 3 months Grunwald et al 53 16 F 36 Basilar artery Penumbra Y—TICI 3 NIHSS 23 at 1 month 7 M 26 L ICA Penumbra Y—TICI 3 NIHSS 0 at 1 month 16 F 26 L M1 segment of MCA Phenox stent Partial recanalisation NIHSS 0 at 1 month Weiner et al 38 15 M 9 R ICA terminus Penumbra Y—TICI 3 NIHSS 1 ICA, internal carotid artery; MCA, middle cerebral artery; mRS, modified Rankin Scale; NA, not applicable; NIHSS, National Institutes of Health Stroke Scale; TICI, thrombolysis in cerebral infarction.
