Introduction: Pediatric strokes are as common as pediatric brain tumors, and are one of the top ten causes of death in children. However, children with stroke often experience a delay in diagnosis, and variable treatment, if any, secondary to a lack of prospective clinical evidence and treatment guidelines.

Methods: We performed a literature search of pediatric stroke cases managed off-label with endovascular treatment.

Results: 51 cases of pediatric strokes were treated with intra-arterial (IA) fibrinolytics (n = 24) or IA-mechanical thrombectomy with or without IV- or IA-fibrinolyotics (n = 27) in patients as young as 2 years old, with a time to treatment averaging 14 hrs and range up to 72 hours. Complete or incomplete recanalization was achieved in 95% of cases. Hemorrhage occurred in 35% (n = 7/20) of patients in the IA-fibrinolytic group alone; but only one of these patients was symptomatic. Only one patient in the IA-mechanical thrombectomy group experienced asymptomatic hemorrhage (4.2%), and this patient also received IA-fibrinolytic therapy.

Conclusions: In the context of recent emerging data supporting the benefits of IA-mechanical thrombectomy in the adult population, we are seeing more case reports emerging in the pediatric literature that support the effectiveness of IA-mechanical thrombectomy with few hemorrhagic complications.

Patient Care: Bring awareness of the status of pediatric stroke epidemiology, diagnosis, and potential IA-mechanical thrombectomy treatment management options in the setting of strong clinical evidence in the adult stroke population for IA-mechanical thrombectomy.

Learning Objectives: 1) Describe the barriers to diagnosis and treatment of pediatric strokes. 2) Discuss the evolution of adult neuro-endovascular stroke management. 3) Review the existing data on neuro-endovascular stroke management in the pediatric population.

References: See attached manuscript.