Kevin O’Connor, MD
International Stroke Conference 2021
March 17–19, 2021
The lack of evidence-based guidelines for endovascular thrombectomy (EVT) in children with acute ischemic stroke has forced institutions to develop their own policies and procedures based on trials in adults and limited pediatric studies. Lauzier et al. describe the framework of their pediatric EVT-capable practices in Seattle and St. Louis. Their joint ventures include co-located (connected structures; St. Louis) or nearby (Seattle) pediatric hospitals and adult comprehensive stroke centers that are guided by interdisciplinary teams comprising pediatric neurologists, radiologists, neurointerventionalists, anesthesiologists, and pediatric intensivists, among others.
Strong collaboration among the multidisciplinary group and advocacy for pediatric stroke patients are integral components of the programs. Their efforts led to formalized and streamlined workflows, including initial triaging of a pediatric stroke case, rapidly acquiring and reviewing imaging studies with MRI/MRA protocols prioritizing DWI and time-of-flight sequences, initiating acute interventions as needed (including intravenous alteplase), and consulting a neurointerventionalist using a pre-specified script. Candidates for pediatric EVT are selected based on consensus inclusion and exclusion criteria developed by the group.