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Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature

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Abstract

Introduction

Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents.

Clinical presentation

We report the case of a 23-month old baby that came to the emergency room of our hospital for progressive impairment of consciousness associated with widespread stiffness and plaintive cry, appeared after accidental fall from stroller. An emergency brain CT scan was obtained showing multiple infarction lesions in the brainstem and left cerebellum suggestive of acute stroke in posterior circulation territories. An MR scan with angiography and diffusion-weighted sequences confirmed the multiple infarction lesions and demonstrated poor representation of the flow signal at the V3 segment of the left vertebral artery and absent representation of the flow signal at the distal segment of the basilar artery suggestive of acute thrombotic occlusion. The patient was immediately referred to interventional neuroradiology unit, and digital subtraction angiography showed complete basilar artery occlusion and left vertebral artery dissection at extracranial V2-V3 segment. The patient underwent intra-arterial thrombectomy using stent retrievers and occlusion of the V2-V3 segment of the left vertebral artery. The patient survived and long-term outcome was excellent.

Conclusions

To our knowledge, only nine cases of ABAO in children treated with intra-arterial thrombectomy have been previously reported in the literature. In only three cases, the Solitaire stent was applied. Our case is the first case of basilar artery occlusion treated with Solitaire stent, in a child under 24 months. The reports that are available so far indicate that basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents.

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Abbreviations

ABAO:

Acute basilar artery occlusion

VAD:

Vertebral artery dissection

AIS:

Acute ischemic stroke

TIA:

Transient ischemic attack

CT:

Computed tomography

MR:

Magnetic resonance

References

  1. Bodey C, Goddard T, Patankar T, Childs AM, Ferrie C, McCullagh H, Pysden K (2014) Experience of mechanical thrombectomy for paediatric arterial ischaemic stroke. Eur J Paediatr Neurol 18:730–735

    Article  PubMed  Google Scholar 

  2. Broderick JP, Berkhemer OA, Palesch YY, Dippel DW, Foster LD, Roos YB, van der Lugt A, Tomsick TA, Majoie CB, van Zwam WH, Demchuk AM, van Oostenbrugge RJ, Khatri P, Lingsma HF, Hill MD, Roozenbeek B, Jauch EC, Jovin TG, Yan B, von Kummer R, Molina CA, Goyal M, Schonewille WJ, Mazighi M, Engelter ST, Anderson CS, Spilker J, Carrozzella J, Ryckborst KJ, Janis LS, Simpson KN, IMS III Investigators; MR CLEAN Investigators (2015) Endovascular therapy is effective and safe for with severe ischemic stroke: pooled analysis of Interventional Management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data. Stroke 46:3416–3422

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Chen MH, SL W, Lo MC, Chen WL, Wang WF (2010) Basilar artery occlusion in a teenaged boy treated with intra-arterial thrombolysis. Acta Neurol Taiwanica 19:280–286

    Google Scholar 

  4. Chikkannaiah M, Lo WD (2014) Childhood basilar artery occlusion: a report of 5 cases and review of the literature. J Child Neurol 29:633–645

    Article  PubMed  Google Scholar 

  5. Devue K, Van Ingelgem A, De Keukeleire K, De Leeuw M (2014) A vertebral artery dissection with basilar artery occlusion in a child. Case Rep Emerg Med 2014:706147

    PubMed  PubMed Central  Google Scholar 

  6. Dubedout S, Cognard C, Cances C, Albucher JF, Cheuret E (2013) Successful clinical treatment of child stroke using mechanical embolectomy. Pediatr Neurol 49:379–382

    Article  PubMed  Google Scholar 

  7. Fan TW, Tang KW, Chan KF, SP W (2003) Vertebral artery dissection in a 5-year-old child: serial magnetic resonance angiography appearance. Hong Kong J Radiol 6:158–161

    Google Scholar 

  8. Fink J, Sonnenborg L, Larsen LL, Born AP, Holtmannspotter M, Kondziella D (2013) Basilar artery thrombosis in a child treated with intravenous tissue plasminogen activator and endovascular mechanical thrombectomy. J Child Neurol 28:1521–1526

    Article  PubMed  Google Scholar 

  9. Fransen PS, Beumer D, Berkhemer OA, van den Berg LA, Lingsma H, van der Lugt A, van Zwam WH, van Oostenbrugge RJ, Roos YB, Majoie CB, Dippel DW, MR CLEAN Investigators (2014) MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials 15:343

    Article  PubMed  PubMed Central  Google Scholar 

  10. Garg B, Ottinger CJ, Smith RR, Fishman MA (1993) Stokes in children due to vertebral artery trauma. Neurology 43:2555–2558

    Article  CAS  PubMed  Google Scholar 

  11. Garnés Sánchez CM, Parrilla G, García Villalba B, Alarcón Martínez H, Martínez Salcedo E, Reyes Domínguez S (2016) A paediatric case of basilar occlusion treated with mechanical thrombectomy using stent retrievers. Neurologia 31:347–350

    Article  PubMed  Google Scholar 

  12. Goeggel Simonetti B, Ritter B, Gautschi M, Wehrli E, Boltshauser E, Schmitt-Mechelke T, Weber P, Weisser M, El-Koussy M, Steinlin M (2013) Basilar artery stroke in childhood. Developmental Medicine & Child Neurology 55:65–70. doi:10.1111/dmcn.12015

    Article  Google Scholar 

  13. Grunwald IQ, Walter S, Shamdeen MG, Dautermann A, Roth C, Haass A, Bolar LJ, Reith W, Kuhn AL (2010) New mechanical recanalization devices—the future in pediatric stroke treatment? J Invasive Cardiol 22:63–66

    PubMed  Google Scholar 

  14. Hasan I, Wapnick S, Tenner MS, Couldwell W (2002) Vertebral artery dissection in children: a comprehensive review. Pediatr Neurosurg 37:168e77

    Article  Google Scholar 

  15. Huded V, Kamath V, Chauhan B, de Souza R, Nair R, Sapare A, Kekatpure M (2015) Mechanical thrombectomy using solitaire in a 6-year-old child. J Vasc Interv Neurol 8:13–16

    PubMed  PubMed Central  Google Scholar 

  16. Khatri P, Yeatts SD, Mazighi M, Broderick JP, Liebeskind DS, Demchuk AM, Amarenco P, Carrozzella J, Spilker J, Foster LD, Goyal M, Hill MD, Palesch YY, Jauch EC, Haley EC, Vagal A, Tomsick TA, Trialists IMSIII (2014) Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. Lancet Neurol 13:567–574

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kuan CY, Hung KL (2014) Vertebral artery dissection complicated by basilar artery occlusion. Pediatr Neonatol 55:316–319

    Article  PubMed  Google Scholar 

  18. Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G (2011) Basilar artery occlusion. Lancet Neurol 10:1002–1014

    Article  PubMed  Google Scholar 

  19. Pfefferkorn T, Holtmannspotter M, Schmidt C, Bender A, Pfister HW, Straube A, Mayer TE, Brückmann H, Dichgans M, Fesl G (2010) Drip, ship, and retrieve: cooperative recanalization therapy in acute basilar artery occlusion. Stroke 41:722–726

    Article  PubMed  Google Scholar 

  20. Provenzale JM (1995) Dissection of the internal carotid and vertebral arteries imaging features. AJR Am J Roentgenol 165:1099–1104

    Article  CAS  PubMed  Google Scholar 

  21. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER, American Heart Association Stroke Council; Council on Cardiovascular Disease in the Young (2008) Management of stroke in infants and children: a scientific statement from a special writing group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 39:2644–2691

    Article  PubMed  Google Scholar 

  22. Rosman NP, Adhami S, Mannheim GB, Katz NP, Klucznik RP, Muriello MA (2003) Basilar artery occlusion in children: misleading presentations, “locked-in” state, and diagnostic importance of accompanying vertebral artery occlusion. J Child Neurol 18:450–462

    Article  PubMed  Google Scholar 

  23. Savastano L, Gemmete JJ, Pandey AS, Roark C, Chaudhary N (2016) Acute ischemic stroke in a child due to basilar artery occlusion treated successfully with a stent retriever. J Neurointervent Surg 8(8):e33

    Article  Google Scholar 

  24. Schievink WI, Mokri B, Piepgras DG (1994) Spontaneous dissections of cervicocephalic arteries in childhood and adolescence. Neurology 44:1607–1612

    Article  CAS  PubMed  Google Scholar 

  25. Sedney CL, Rosen CL (2011) Cervical abnormalities causing vertebral artery dissection in children. J Neurosurg Pediatr 7:272–275

    Article  PubMed  Google Scholar 

  26. Stidd DA, Lopes DK (2014) Successful mechanical thrombectomy in a 2-year-old male through a 4-French guide catheter. Neurointervention 9:94–100

    Article  PubMed  PubMed Central  Google Scholar 

  27. Taneja SR, Hanna I, Holdgate A, Wenderoth J, Cordato DJ (2011) Basilar artery occlusion in a 14-year old female successfully treated with acute intravascular intervention: case report and review of the literature. J Paediatr Child Health 47:408–414

    Article  PubMed  Google Scholar 

  28. Tatum J, Farid H, Cooke D, Fullerton H, Smith W, Higashida R, Halbach VV, Dowd C (2013) Mechanical embolectomy for treatment of large vessel acute ischemic stroke in children. J Neurointerv Surg 5:128–134

    Article  PubMed  Google Scholar 

  29. Touré A, Chabrier S, Plagne MD, Presles E, des Portes V, Rousselle C (2009) Neurological outcome and risk of recurrence depending on the anterior vs. posterior arterial distribution in children with stroke. Neuropediatrics 40:126–128

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Santobono- Pausillipon Children’s Hospital, Naples, Italy

    Giancarlo Nicosia, Giuseppe Mirone, Pietro Spennato, Vincenzo Trischitta, Claudio Ruggiero & Giuseppe Cinalli

  2. Department of Health Sciences, University of L’Aquila, L’Aquila, Italy

    Giancarlo Nicosia

  3. Paediatric Neuroradiology Unit, Santobono- Pausillipon Children’s Hospital, Naples, Italy

    Domenico Cicala

  4. Diagnostic and Interventional Neuroradiology Unit, AORN Cardarelli Hospital, Naples, Italy

    Gianluigi Guarneri & Mario Muto

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  1. Giancarlo Nicosia
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  2. Domenico Cicala
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Correspondence to Pietro Spennato.

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Nicosia, G., Cicala, D., Mirone, G. et al. Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature. Childs Nerv Syst 33, 349–355 (2017). https://doi.org/10.1007/s00381-016-3259-z

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  • DOI: https://doi.org/10.1007/s00381-016-3259-z

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