Mechanical thrombectomy for pediatric acute stroke and ventricular assist device

Background Certain pediatric populations have increased risk of ischemic strokes, including those with cardiac disease and those dependent on mechanical circulatory devices such as ventricular assist devices. Due to their need for chronic anticoagulation, patients with mechanical circulatory devices are not candidates for systemic thrombolysis and thus treatment of acute ischemic stroke is limited. Case A 9-year-old boy with a ventricular assist device presented with acute onset of dense right hemiparesis, global aphasia, and a pediatric NIHSS score of 23. Vessel imaging showed an occlusive proximal left middle cerebral artery thrombus successfully removed via mechanical thrombectomy within 4.5 h of symptom onset. His pediatric NIHSS 72 h after presentation was 3. Conclusions This case represents only the third report of successful mechanical thrombectomy for acute ischemic stroke in a pediatric patient with a ventricular assist device and the first using the Trevo stent retriever system. Our patient's excellent outcome highlights mechanical thrombectomy as a potential therapeutic option for children with ventricular assist devices experiencing acute neurological changes and radiologic evidence of proximal vessel occlusion.