Dados do Trabalho

Título

TIMELY INTERVENTION IN PEDIATRIC STROKE: A CASE REPORT OF A 10-YEAR-OLD PATIENT UNDERGOING ENDOVASCULAR THROMBECTOMY WITHIN THE HYPERACUTE PHASE

Apresentação do caso único

A 10-year-old male with congenital heart disease, on anticoagulant therapy, was admitted to the ICU after the identification of an intracardiac thrombus in a routine echocardiogram. On the fifth day of hospitalization, he presented an acute onset strength deficit. Upon evaluation, he exhibited dysarthria and complete left-sided hemiplegia, scoring eight points on the NIH Stroke Scale. A CT scan identified an occlusion in the M1 branch of the right middle cerebral artery. Due to the use of enoxaparin, thrombolysis was contraindicated. Endovascular thrombectomy was performed three hours and thirty minutes after the onset of symptoms. There was an improvement in the deficit, and within the first 24 hours post-procedure, he scored only one point on the NIH Stroke Scale. Due to his heart condition, unfractionated heparin was initiated within the first 24 hours, with aPTT monitoring, and switched to low molecular weight heparin after four days. MRI confirmed an ischemic area affecting the right caudate nucleus and putamen. He was discharged after two week with grade four strength in the left upper limb, no dysarthria, and preserved gait, scoring only one point on the modified Rankin Scale. He maintained outpatient follow-up, and cardioembolism was identified as the most likely etiology after etiological investigation.

Discussão

This report highlights the experience of a pediatric neurology team in managing a case of pediatric ischemic stroke treated with endovascular thrombectomy, resulting in successful recanalization. The positive outcome aligns with the literature on thrombectomy in the pediatric population. Establishing treatment protocols related to hyperacute recanalization therapies in this age group is a crucial step to make them more accessible to patients. The case also promotes discussion about the possibility of early reintroduction of anticoagulation and the routines that should be established post-procedure, such as blood pressure targets and the frequency of imaging exams.

Comentários finais

Endovascular thrombectomy is becoming an established treatment option for hyperacute recanalization in pediatric stroke, with growing evidence of its safety and efficacy. However, there is still a lack of clear guidelines for patient selection, thrombectomy techniques, and post-procedure care. Extrapolation of adult guidelines is common, but the anatomical and physiological particularities of children must be considered, as well as the expertise of the neurointervention team.

Referências

-SUN, Lisa R.; HARRAR, Dana; DROCTON, Gerald; CASTILLO-PINTO, Carlos; FELLING, Ryan; CARPENTER, Jessica L.; WERNOVSKY, Gil; McDOUGALL, Cameron G.; GAILLOUD, Philippe; PEARL, Monica S. Mechanical Thrombectomy for Acute Ischemic Stroke: Considerations in Children. Stroke, v. 52, p. 381–384, 2021. DOI: 10.1161/STROKEAHA.120.031133.
-MASTRANGELO, Mario; GIORDO, Laura; RICCIARDI, Giacomina; et al. Acute ischemic stroke in childhood: a comprehensive review. European Journal of Pediatrics, v. 181, p. 45–58, 2022. DOI: https://doi.org/10.1007/s00431-021-04212-x.
- CHABRIER, Stéphane; OZANNE, Augustin; NAGGARA, Olivier; BOULOIS, Grégoire; HUSSON, Béatrice; KOSSOROTOFF, Manoëlle. Hyperacute Recanalization Strategies and Childhood Stroke in the Evidence Age. Stroke, v. 52, p. 381–384, 2021. DOI: 10.1161/STROKEAHA.120.031133.
-SHOIRAH, Hazem; SHALLWANI, Hussain; SIDDIQUI, Adnan H.; LEVY, Elad I.; KENMUIR, Cynthia L.; JOVIN, Tudor G.; LEVITT, Michael R.; KIM, Louis J.; GRIAUZDE, Julius; PANDEY, Aditya S.; GEMMETE, Joseph J.; ABRUZZO, Todd; ARTHUR, Adam S.; ELIJOVICH, Lucas; HOIT, Daniel; CHEEMA, Ahmed; AGHAEBRAHIM, Amin A.; SAUVAGEAU, Eric; HANEL, Ricardo; RINGER, Andrew J.; NASCIMENTO, Fábio A.; KAN, Peter; MOCCO, J. Endovascular thrombectomy in pediatric patients with large vessel occlusion. Journal of NeuroInterventional Surgery, v. 0, p. 1–4, 2019. DOI: 10.1136/neurintsurg-2018-014320.

Fonte de Fomento (se houver)

Não

Palavras Chave

ischemic stroke; thrombectomy; intensive care