Abstract WP57: Utility of Flat Panel CT Perfusion for Physiologic Assessment of Acute Ischemic Stroke in the Angiography Suite

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Robert W Ryan ◽  
Paula Eboli ◽  
Michael J Alexander ◽  
Shlee S Song ◽  
Marcel M Maya ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Defect ◽  
Ct Perfusion ◽  
Endovascular Intervention ◽  
Flat Panel ◽  
Post Intervention ◽  
Angiography Suite ◽  
Before And After

Introduction The decision to perform endovascular intervention in patients with acute ischemic stroke (AIS) may be guided by physiologic imaging such as CT perfusion (CTP) demonstrating a salvageable penumbra, but such studies can delay transfer to the angiography suite. Flat Panel Detector CT (FPD-CT) allows pre, intra and post-procedural physiologic assessment using rotational images acquired on the angiography table; however these measurements have not been correlated with conventional perfusion techniques. We began a prospective, observational comparison of standard, multi-slice CTP with FPD-CT perfusion for AIS interventions, and report our initial results. Methods Patients with AIS that are candidates for endovascular intervention and have standard CTP images available were enrolled in the study after obtaining informed consent and following the IRB approved protocol. FPD-CTP images were obtained with aortic contrast injection and commercially available workstation image assessment (Siemens, Erlangen, Germany) before and after intervention, and compared with standard CT perfusion and follow up images. Results A total of 3 cases have been enrolled. All demonstrated anatomic correlations between perfusion defects in the standard CTP and the FPD-CTP. Case example: A 58 year old man developed left sided hemiplegia and standard CTP demonstrated a right MCA defect with a small core infarction (Fig 1 A). Pre-intervention FPD-CTP showed the same defect pattern (Fig 1 B), and successful mechanical thrombectomy was performed (Fig 1 C,D). Post-intervention FPD-CT showed reversal of perfusion defect outside the core infarct (Fig 1 E). The patient had good clinical recovery and only small infarct on follow up CT (Fig 1 F). Conclusions Early experience with FPD-CTP imaging shows correlation with standard CTP images and reversal of perfusion defect following successful recanalization, suggesting it may be a valuable aid for decision making in AIS intervention.

Assessment of computed tomography perfusion software in predicting spatial location and volume of infarct in acute ischemic stroke patients: a comparison of Sphere, Vitrea, and RAPID

2020 ◽  
pp. neurintsurg-2020-015966 ◽  
Author(s):  
Ryan A Rava ◽  
Kenneth V Snyder ◽  
Maxim Mokin ◽  
Muhammad Waqas ◽  
Xiaoliang Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Conservative Treatment ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Ct Perfusion ◽  
Intravenous Thrombolysis ◽  
Spatial Location ◽  
Endovascular Intervention ◽  
Vessel Occlusion

BackgroundCT perfusion (CTP) infarct and penumbra estimations determine the eligibility of patients with acute ischemic stroke (AIS) for endovascular intervention. This study aimed to determine volumetric and spatial agreement of predicted RAPID, Vitrea, and Sphere CTP infarct with follow-up fluid attenuation inversion recovery (FLAIR) MRI infarct.Methods108 consecutive patients with AIS and large vessel occlusion were included in the study between April 2019 and January 2020 . Patients were divided into two groups: endovascular intervention (n=58) and conservative treatment (n=50). Intervention patients were treated with mechanical thrombectomy and achieved successful reperfusion (Thrombolysis in Cerebral Infarction 2b/2 c/3) while patients in the conservative treatment group did not receive mechanical thrombectomy or intravenous thrombolysis. Intervention and conservative treatment patients were included to assess infarct and penumbra estimations, respectively. It was assumed that in all patients treated conservatively, penumbra converted to infarct. CTP infarct and penumbra volumes were segmented from RAPID, Vitrea, and Sphere to assess volumetric and spatial agreement with follow-up FLAIR MRI.ResultsMean infarct differences (95% CIs) between each CTP software and FLAIR MRI for each cohort were: intervention cohort: RAPID=9.0±7.7 mL, Sphere=−0.2±8.7 mL, Vitrea=−7.9±8.9 mL; conservative treatment cohort: RAPID=−31.9±21.6 mL, Sphere=−26.8±17.4 mL, Vitrea=−15.3±13.7 mL. Overlap and Dice coefficients for predicted infarct were (overlap, Dice): intervention cohort: RAPID=(0.57, 0.44), Sphere=(0.68, 0.60), Vitrea=(0.70, 0.60); conservative treatment cohort: RAPID=(0.71, 0.56), Sphere=(0.73, 0.60), Vitrea=(0.72, 0.64).ConclusionsSphere proved the most accurate in patients who had intervention infarct assessment as Vitrea and RAPID overestimated and underestimated infarct, respectively. Vitrea proved the most accurate in penumbra assessment for patients treated conservatively although all software overestimated penumbra.

Abstract W MP20: Automation and Quantification of the Angiographic Capillary Blush in Patients with Acute Ischemic Stroke undergoing Endovascular Intervention

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jason Tarpley ◽  
Fabien Scalzo ◽  
Jeffry R Alger ◽  
Amin Aghaebrahim ◽  
Conrad Liang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Blood Volume ◽  
Spatial Information ◽  
Endovascular Intervention ◽  
Ordinal Scale ◽  
Conventional Angiography ◽  
Non Invasive ◽  
Angiography Suite ◽  
Scale Properties

Background: In acute ischemic stroke, non-invasive perfusion imaging can guide the decision to perform endovascular intervention. A subset of these patients who are ineligible for IV TPA or for whom it has failed may benefit by going directly to endovascular intervention without delays imposed by non-invasive imaging. In these patients, an angiographic biomarker of viable brain tissue such as the capillary blush described by the Capillary Index Score (CIS) will be important for decision making in the angiography suite. Indeed, a favorable CIS score is associated with good outcomes when recanalization is achieved. However, any ordinal angiographic scale is observer dependent and limited by scale properties. Methods: Here we used our novel perfusion angiography software (PerfAngio) to extract cerebral blood volume (CBV) maps from conventional angiograms acquired during endovascular intervention at either UPMC or UCLA. Areas of angiographic blush were selected manually from a subset of the angiograms. These blush areas trained a machine learning model to identify features of angiographic blush from CBV maps to produce blush maps. Results: In the figure, we show PerfAngio’s blush map in a patient with acute proximal MCA occlusion prior to endovascular recanalization. At each pixel cool colors represent low likelihood of capillary blush and hotter colors represent higher likelihood of blush. These color maps allow for spatial characterization of the blush and quantifies it as a continuous variable rather than according to an ordinal scale. Conclusions: PerfAngio blush maps allow for automation and quantification of the blush seen during conventional angiography. These maps render data that does not depend on observer interpretation and provide spatial information about the capillary blush that is not captured by the CIS. Since PerfAngio blush maps can be acquired in real time, they are amenable for use in the angiography suite to inform the decision to recanalize or not.

Abstract 161: Lean Process Improvements Reduce Door to CT and Door to Needle Times for Acute Ischemic Stroke Patients

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cory McCann ◽  
Aleks Tkach ◽  
Adam de Havenon ◽  
Joel Loosli ◽  
Jamie Troyer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Improve Patient Safety ◽  
Post Intervention ◽  
Process Improvements ◽  
Slowing Down ◽  
Before And After ◽  
Ct Brain ◽  
Student’S T ◽  
First Time

Background: In late 2015, we assembled a multi-disciplinary team to analyze current emergency department (ED) processes and identify improvement opportunities in the current “brain attack” (BA) protocol. Using lean process engineering tools, including time study analysis, gemba walks, and cause and effect diagrams, we mapped our baseline state and identified delaying activities that did not add value to the BA process. We defined a new BA process (see Figure 1) to eliminate waste and improve team communication, including 3 Time Outs to ensure that increased speed didn’t decrease safety. Methods: To determine the effect of our intervention, we retrospectively reviewed patients who were admitted to our ED as a BA for evaluation of possible acute ischemic stroke and had a CT brain after ED arrival between April 2015 and August 2016. ED arrival was defined as the time that patients physically arrived at the ED and “time to CT” was the time from ED arrival to the first time stamp of the CT brain. The time from ED arrival to tPA bolus was also measured for "door to needle" time. The time to CT and door to needle times were compared between BA patients before and after lean process improvements using Student’s T-test. Results: Our cohort included 239 patients who presented to the ED as a BA. We included 116 BA patients from before the intervention and 123 from afterwards. The mean±SD time to CT prior to the intervention was 19.0±13.9 minutes. After our lean process improvements the time to CT was 14.2±15.6 minutes. The delta of 4.8 minutes resulted in a significant reduction in time to CT, p = 0.012. There were 14 patients who received tPA prior to the intervention and 9 afterwards, for a total of 23 door to needle times (10% of cohort). Door to needle time was significantly shortened post-intervention (46±13 minutes versus 32±12 minutes, p=0.013). Conclusions: Lean process improvement methodology significantly reduces door to CT and door to needle times, supporting current AHA Target: Stroke goals and allowing faster treatment of patients with acute ischemic stroke. Incorporating time-outs into standardized processes that aim to deliver care more quickly may improve patient safety without substantially slowing down DTN times. Further investigation is required to determine whether the new process improved safety and clinical outcomes.

Abstract WMP15: A Simple Tool to Predict Target Mismatch in Ischemic Stroke Patients with Anterior Circulation Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adam de Havenon ◽  
Steve O’Donnell ◽  
Alex Linn ◽  
Scott McNally ◽  
Bailey Dunleavy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Time Window ◽  
Ct Perfusion ◽  
Volumetric Analysis ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Ct Angiogram

Introduction: The efficacy of endovascular thrombectomy in an extended time window for acute ischemic stroke patients with Target Mismatch (TM) on perfusion imaging was shown in a recent study and the ongoing DEFUSE-3 trial is studying thrombectomy in a 6-16 hour window for TM patients. A limitation of TM is that perfusion imaging is not widely available. We sought to identify a tool to predict TM based on clinical factors and CT angiogram (CTA) imaging, which is available at most hospitals. Methods: We reviewed acute ischemic stroke patients from 2010-2014 with proximal middle cerebral artery occlusion, CTA and CT perfusion (CTP) at hospital admission. TM was identified on CTP using the Olea Sphere volumetric analysis software with Bayesian deconvolution. TM was defined by the DEFUSE-3 criteria. ASPECTS was derived from the non-contrast CT head and the CTA source images (CTA-ASPECTS). Two collateral scores were derived from CTA source images. Results: 61 patients met inclusion criteria. The mean±SD age was 61±18 years and 61% were male. Mean NIH Stroke Scale (NIHSS) was 14.1±8.0 and median (IQR) follow-up modified Rankin Scale was 3 (1,6). TM was present in 35/61 (57%), who had lower mRS at follow-up (z=3.5, p<0.001). The predictor variables are shown in Table 1. The best combination of predictors was CTA-ASPECTS >4 and NIHSS <16, which had a sensitivity of 80% and specificity of 85% for TM (Figure 1). Discussion: We report a reliable, accessible, and clinically useful tool for predicting TM. This score warrants further study as a tool to guide transfer decisions from primary or secondary stroke centers to tertiary centers where endovascular intervention would be possible for selected patients.

scholarly journals Early Single Center Experience with the Solitaire Thrombectomy Device for the Treatment of Acute Ischemic Stroke

2011 ◽  
Vol 17 (2) ◽  
pp. 235-240 ◽  
Author(s):  
M. Wehrschuetz ◽  
E. Wehrschuetz ◽  
M. Augustin ◽  
K. Niederkorn ◽  
H. Deutschmann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Artery Occlusion ◽  
Single Center Experience ◽  
Early Results ◽  
Distal Branch ◽  
Before And After ◽  
Thrombectomy Device ◽  
Cerebral Artery Occlusion

We report the immediate technical and clinical outcome of a new self-expanding fully retrievable stent in the treatment of acute ischemic stroke. Eleven consecutive patients with acute intracerebral artery occlusions were treated with a self-expandable fully retrievable intracranial stent (Solitaire AB). Four patients had an occlusion of the basilar artery, five had a middle cerebral artery occlusion and two had terminal carotid artery occlusions. Recanalization results were assessed by follow-up angiography immediately after the procedure. Neurologic status was evaluated before and after treatment (90-day follow-up) according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scales (mRS). Successful revascularization (TICI 2a/b and 3) was achieved in 11 of 11 (100%) patients, a TICI 3 state was accomplished in two (18%) patients, and partial recanalization or slow distal branch filling with filling of more than two-thirds of the vessel territory (TICI 2a/2b) was achieved in nine (82%) patients. The stent was removed in all patients. The mean time from stroke symptom onset to recanalization was 339 minutes (+/– 114.3 minutes). NIHSS on admission was 16.09 (+/– 4.7). Almost two-thirds of the patients (61.2%) improved by >6 points on the NIHSS at discharge, and 30% showed a mRS of <2 at 90 days. Mortality was 9%. One patient with a BA occlusion had a massive brain stem infarction and died two days after the procedure. There were no intracranial hemorrhages. The use of the Solitaire in ischemic stroke patients shows encouraging results. However, further prospective large randomized trials are mandatory to confirm these early results.

Total and regional ASPECT score for non-contrast CT, CT angiography, and CT perfusion: inter-rater agreement and its association with the final infarction in acute ischemic stroke patients

2021 ◽  
pp. 028418512110290
Author(s):  
Yue Chu ◽  
Gao Ma ◽  
Xiao-Quan Xu ◽  
Shan-Shan Lu ◽  
Yue-Zhou Cao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Caudate Nucleus ◽  
Ct Angiography ◽  
Ct Perfusion ◽  
Internal Capsule ◽  
Rater Agreement ◽  
Caudate Nuclei

Background Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a grading system to assess the extent and distribution of early ischemic changes. Purpose To assess inter-rater agreement for total and regional ASPECTS on non-contrast computed tomography (NCCT) images, CT angiography source images (CTA-SI), and CT-perfusion cerebral blood volume (CTP-CBV) maps, and their association with final infarction in patients with acute ischemic stroke (AIS). Material and Methods A total of 96 consecutive patients with AIS who underwent pre-treatment NCCT and CTP were retrospectively enrolled. CTA-SI was reconstructed using the raw data of CTP. Total and regional ASPECTS were assessed on baseline NCCT, CTA-SI, and CTP-CBV, and on follow-up NCCT or diffusion-weighted imaging. Follow-up ASPECTS served as the reference standard for final infarction. Results CTP-CBV demonstrated higher concordance for total ASPECTS (interclass correlation coefficient, 0.895 vs. 0.771 vs. 0.777) and regional ASPECTS in internal capsule, lentiform, caudate nuclei, M5 and M6, compared with NCCT and CTA-SI. CTP-CBV showed a trend of stronger correlation with final ASPECTS than NCCT and CTA-SI (0.717 vs. 0.711 vs. 0.565; P > 0.05). ASPECTS in the internal capsule (ρ, 0.756 vs. 0.556; P = 0.016) and caudate nucleus (ρ, 0.717 vs. 0.476; P = 0.010) on CTP-CBV were more strongly correlated with follow-up ASPECTS than NCCT. CTP-CBV showed higher accuracy for predicting final infarction in the internal capsule (92.5% vs. 90.3% and 87.1%; P > 1.000, P = 0.125, respectively) and caudate nucleus (87.1% vs. 79.6% and 77.4%; P = 0.453, P = 0.039, respectively) than CTA-SI and NCCT. Conclusion CTP-CBV ASPECTS might be more reliable for delineating early ischemic changes and predicting final infarction.

Abstract 2851: Intravenous Heparin For The Treatment Of Intraluminal Thrombus In Patients With Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Maxim Mokin ◽  
Tareq Kass-Hout ◽  
Omar Kass-Hout ◽  
Peter Kan ◽  
Adnan Siddiqui ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Heart Association ◽  
Bleeding Complications ◽  
Intraluminal Thrombus ◽  
Computed Tomographic ◽  
Increased Risk ◽  
Before And After ◽  
Complete Lysis

Background and objectives: Current American Stroke Association/American Heart Association recommendations on the management of acute ischemic stroke do not recommend early use of heparin owing to increased risk of bleeding complications. However, for select patients, such as those with strokes associated with intraluminal thrombus, intravenous (IV) heparin might prove to be beneficial. Methods: We conducted a retrospective analysis of acute ischemic stroke cases associated with intraluminal thrombus of intracranial and extracranial arteries in the corresponding vascular territories to identify patients in whom treatment with IV heparin resulted in near-complete or complete lysis of the thrombus. Imaging findings from computed tomographic (CT) perfusion and angiography, magnetic resonance imaging, and/or digital subtraction angiography were used to describe the location of intraluminal thrombus immediately before and after treatment with IV heparin. Results: Eighteen patients with confirmed intraluminal thrombus by CT angiography (CTA) received treatment with IV heparin alone (median duration 3.5 days; range 1-8 days). The median NIHSS score was 2.5 (range 0-15) on admission and 1 (range 0-9) at discharge. Nine patients had complete lysis, and 9 patients had partial lysis of the thrombus with improved flow distal to the location of the thrombus. None of the patients developed intracranial hemorrhage. Conclusion: For strokes associated with intraluminal thrombus, IV heparin might prove to be an effective treatment strategy. Further studies are necessary to evaluate the efficacy and safety of treatment with IV heparin in those patients.

Abstract 75: Hemorrhagic Transformation After Acute Ischemic Stroke Due to a Large Vessel Occlusion is Associated With Less Treatment Benefit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Katinka R van Kranendonk ◽  
Manon Kappelhof ◽  
Vicky Chalos ◽  
Kilian M Treurniet ◽  
Wim van Zwam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
Vessel Occlusion ◽  
Treatment Benefit ◽  
Natural Progression ◽  
Before And After

Introduction: Intracranial hemorrhage after acute ischemic stroke patients manifests as natural progression or as a complication of treatment with potential subsequent neurological deterioration. Currently it is unclear whether these hemorrhagic transformations (HT) contribute to the poorer functional outcomes observed in patients with large infarcts. The purpose of this study is to assess the association of HT with follow-up infarct volume (FIV) and functional outcome at 90 days after AIS. Additionally, we determined whether the development of HT was associated with a diminished endovascular therapy (EVT) effect. Methods: All patients from the HERMES collaboration with follow-up imaging were included. HERMES is pooled data from seven randomized controlled trials that assessed the efficacy and safety of EVT compared to usual care. Patients with HT were identified according to the ECASS classification and FIV was assessed on CT or MRI. Infarct and hemorrhage were included in the FIV. We assessed functional outcome using the modified Rankin Scale 90 days after stroke onset. Ordinal logistic regression with adjustment for potential confounders was used to determine the association of HT and FIV with functional outcome. Results: Of all included patients with follow-up imaging (n=1665), 42% had HT (n=698). Before and after adjustment for confounders HT and FIV were associated with a shift in the direction of poorer functional outcome (aOR:0.71,95%CI:0.58-0.86 and aOR:0.99,95%CI:0.99-0.99). EVT was beneficial in patients with and without HT, but effect was greater in patients without (aOR:1.70,95%CI:1.27-2.28 vs. aOR:2.51,95%CI:1.97-3.20)(figure 1.) Conclusions: In this analysis, patients with HT after AIS were less likely to have good functional outcome compared to those without HT, independent of the FIV. While the EVT effect was slightly diminished in patients who developed HT, EVT was always of significant benefit.

Abstract WP24: Improvement In Collateral Score And Level Of Occlusion Are Early Angiographic Indicators Of The Degree of Infarction In Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Matthew R Amans ◽  
Maya Vella ◽  
Daniel L Cooke ◽  
Steven W Hetts
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Brain Infarction ◽  
Arterial Occlusion ◽  
Brain Parenchyma ◽  
Post Intervention ◽  
Vessel Occlusion ◽  
Post Procedure ◽  
Before And After ◽  
Cerebral Arterial Occlusion

INTRODUCTION: Brain parenchyma contrast staining on CT after recanalization therapy and digital subtraction angiography (DSA) in large vessel occlusion acute ischemic stroke (LVO-AIS) patients has been demonstrated to be a marker for significant brain injury, possibly indicating blood brain barrier breakdown or no-reflow phenomena at the capillary level. Most often stained parenchyma undergoes infarction. We evaluated several DSA parameters in order to determine if findings on DSA at the time of LVO-AIS intervention can predict postintervention parenchymal contrast staining on CT and, thus, serve as early prognostic factors for brain infarction. HYPOTHESIS: Point of cerebral arterial occlusion, TICI score, and degree of pial collateraliation correlate with presence of parenchymal contrast staining on post-intervention CT in LVO-AIS patients. METHODS: Our institution’s CHR approved this analysis of imaging and patient charts. We reviewed 17 years of LVO-AIS intervention at our institution, and 67 patients met inclusion criteria. Angiograms were evaluated for level of occlusion, TICI scores before and after intervention, and level of collateralization before and after intervention. Statistical analysis was performed using Fisher’s exact test and ANOVA. RESULTS: More proximal sites of cerebral arterial occlusion were more likely patients to have post-intervention staining (p=0.08). Preprocedure TICI, postprocedure TICI and improvement in TICI score did not predict contrast staining on post procedure CT (p=0.34, 0.54, and 0.52). Preprocedure collateral score, post procedure collateral score were similarly not predictive (p=0.28 and 0.93). Decreasing collateral score (i.e., increased antegrade flow with decreased need for collateral supply) was predictive of contrast staining (p=0.09). CONCLUSION: Improvement in pial collateral score was more predictive of postprocedure contrast staining than was change in TICI grade, and thus may serve as a complement to TICI in the assessment of revascularization efficacy at the time of stroke intervention.

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

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