Attention after Thrombectomy in Pediatric Stroke: Keep in Mind the Possibility of a Progressive Stenosing Cerebral Vasculopathy

Background: In childhood ischemic strokes, the impact of recanalization procedures like thrombectomy is unclear, considering the different causes for stroke compared with adults, for example, intracerebral stenosing vasculitis, which is observed in childhood.

Case Reports: In 2015, in two children with ischemic stroke, treated in the University Children’s Hospital in Münster, a thromboembolism was suspected that led to the decision for a thrombectomy: In the first patient, a 4-year-old boy with acute leukemia, an ischemia of the middle cerebral artery (MCA), occurred in protocol I, a risk period in the treatment protocol for thromboembolic events. After a successful thrombectomy, a progressive stenosis of the MCA and other intracerebral arteries developed with complete infarction of the left hemisphere in the following weeks. Under the suspicion of a cerebral vasculitis, immunosuppressive therapy was achieved and led to an improvement of the vasculopathy. The second patient, a 16-year-old girl, suffered from a MCA occlusion, which was successfully treated by thrombectomy within 6 hours. Two days later, ultrasound uncovered a stenosis of the MCA, the carotid T, and the anterior cerebral artery, so a rapidly progressive cerebral vasculitis was diagnosed and immunosuppressive therapy was started, which led to a stabilization of the stenoses.

Conclusion: In selected cases of childhood strokes, thrombectomy might be feasible. But an obviously thromboembolic stroke does not exclude a progressive stenosing cerebral vasculopathy. So the individual course with regard to the intracerebral arteries necessitates a close monitoring even after recanalization to detect progressive vasculopathies such as cerebral vasculitis and initiate appropriate therapy.