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Case ReportNeurointervention

Mechanical Thrombectomy for Pediatric Arterial Ischemic Stroke from Acute M2 Occlusion

Kartik D. Bhatia, Elizabeth Pulcine, Ian Andrews, Sachin Gupta, Richard Webster, Christopher Troedson, Russell C. Dale, Michelle Lorentzos, Carmen Parra-Farinas, John Worthington, Kylie Tastula, Timothy Ang, Andrew Cheung, Nathan Manning and Prakash Muthusami
American Journal of Neuroradiology March 2024, DOI: https://doi.org/10.3174/ajnr.A8182
Kartik D. Bhatia
aFrom the Department of Medical Imaging (K.D.B.), Children’s Hospital at Westmead, Westmead, New South Wales, Australia
bFaculty of Medicine and Health (K.D.B., S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead Clinical School, University of Sydney, New South Wales, Australia
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  • ORCID record for Kartik D. Bhatia
Elizabeth Pulcine
cDivision of Neurology (E.P.), Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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Ian Andrews
dDepartment of Neurology (I.A.), Sydney Children’s Hospital, Randwick, New South Wales, Australia
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Sachin Gupta
bFaculty of Medicine and Health (K.D.B., S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead Clinical School, University of Sydney, New South Wales, Australia
eT.Y. Nelson Department of Neurology and Neurosurgery (S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Richard Webster
bFaculty of Medicine and Health (K.D.B., S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead Clinical School, University of Sydney, New South Wales, Australia
eT.Y. Nelson Department of Neurology and Neurosurgery (S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Christopher Troedson
bFaculty of Medicine and Health (K.D.B., S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead Clinical School, University of Sydney, New South Wales, Australia
eT.Y. Nelson Department of Neurology and Neurosurgery (S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Russell C. Dale
bFaculty of Medicine and Health (K.D.B., S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead Clinical School, University of Sydney, New South Wales, Australia
eT.Y. Nelson Department of Neurology and Neurosurgery (S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Michelle Lorentzos
bFaculty of Medicine and Health (K.D.B., S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead Clinical School, University of Sydney, New South Wales, Australia
eT.Y. Nelson Department of Neurology and Neurosurgery (S.G., R.W., C.T., R.C.D., M.L.), Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Carmen Parra-Farinas
fDivision of Image-Guided Therapy (C.P.F., P.M.), Department of Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
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John Worthington
gDepartment of Neurology (J.W., K.T., T.A.), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Kylie Tastula
gDepartment of Neurology (J.W., K.T., T.A.), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Timothy Ang
gDepartment of Neurology (J.W., K.T., T.A.), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Andrew Cheung
hInterventional Radiolog (A.C., N.M.), Sydney Children’s Hospital, Randwick, New South Wales, Australia
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Nathan Manning
hInterventional Radiolog (A.C., N.M.), Sydney Children’s Hospital, Randwick, New South Wales, Australia
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Prakash Muthusami
fDivision of Image-Guided Therapy (C.P.F., P.M.), Department of Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
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    FIG 1.

    Oblique anterior-posterior-projection DSA images with a right ICA injection during a mechanical thrombectomy procedure. An 11-month-old infant (patient 4 in the Online Supplemental Data) with congenital cardiac disease had reduced movement of the left upper limb and face after waking from a nap. CTA demonstrated a right MCA proximal M2 occlusion. A, Subocclusive thrombus involving the proximal aspect of the right MCA superior M2 division (white arrow). B, Following a single-pass mechanical thrombectomy with a 3-mm-diameter stent retriever, angiographic vasospasm was present in the recanalized vessel segment (white arrow). C, Vasospasm resolution was noted after intra-arterial infusion of verapamil (1.5 mg) via the right ICA 4F catheter. The ped-mRS score at 3 months was 1.

  • FIG 2.
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    FIG 2.

    A 3-year-old patient (patient 3 in the Online Supplemental Data) developed fluctuating weakness of the left upper limb (Ped-NIHSS 3) after recent cardiac surgery for cor triatriatum. A, Axial CT angiogram demonstrates a filling defect in the right MCA distal M1 segment (black arrow). B, Lateral-projection DSA image with a right ICA injection demonstrates interval migration of the thrombus to the right MCA posterior (perirolandic) mid-M2 division (white arrow). After multidisciplinary discussion regarding the potential long-term disabling impact of a perirolandic infarct, it was agreed to proceed to the mechanical thrombectomy. C, After 2 passes with a 3-mm-diameter stent retriever, there was successful recanalization of the right perirolandic posterior M2 division. The ped-mRS score at 3 months was 0.

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Kartik D. Bhatia, Elizabeth Pulcine, Ian Andrews, Sachin Gupta, Richard Webster, Christopher Troedson, Russell C. Dale, Michelle Lorentzos, Carmen Parra-Farinas, John Worthington, Kylie Tastula, Timothy Ang, Andrew Cheung, Nathan Manning, Prakash Muthusami
Mechanical Thrombectomy for Pediatric Arterial Ischemic Stroke from Acute M2 Occlusion
American Journal of Neuroradiology Mar 2024, DOI: 10.3174/ajnr.A8182

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Mechanical Thrombectomy for Pediatric Arterial Ischemic Stroke from Acute M2 Occlusion
Kartik D. Bhatia, Elizabeth Pulcine, Ian Andrews, Sachin Gupta, Richard Webster, Christopher Troedson, Russell C. Dale, Michelle Lorentzos, Carmen Parra-Farinas, John Worthington, Kylie Tastula, Timothy Ang, Andrew Cheung, Nathan Manning, Prakash Muthusami
American Journal of Neuroradiology Mar 2024, DOI: 10.3174/ajnr.A8182
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