Affiliations: Neurointerventional Radiology Section, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA | Department of Neurosurgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA | Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA | Neurointerventional Radiology Division, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
Note:  Corresponding author: Darren B. Orbach, Neurointerventional Radiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Tel.: +1 617 355 5012; Fax: +1 617 730 0382; E-mail: [email protected]
Abstract: The assessment and interventional management of pediatric arterial ischemic stroke (AIS) in the acute setting is a challenge, given the lack of safety and efficacy data on available treatment options and the absence of detailed guidelines specific for children. Endovascular therapy in pediatric AIS must be considered experimental and approached cautiously in order to minimize adverse outcomes, as there are no published studies or prospective clinical trials investigating the safety and efficacy of intra-arterial thrombolysis or mechanical thrombectomy in the management of pediatric AIS. Additional complicating factors include typically increased delays and increased challenge to appropriate diagnosis in children relative to adults, and underlying differences in the pathophysiology of AIS, the thrombotic cascade, and the natural history of AIS in children. Judicious extrapolation of adult data might be used for treatment of these cases with a highly individualized approach at high-volume centers, by a neurointerventional team in close collaboration with pediatric stroke neurologists. Mechanical approaches may be a safe and potentially effective therapeutic option.