Tang Jun,Liang Ping.Endovascular therapy for pediatric cerebrovascular disease: clinical advances and considerations[J].Journal of Clinical Pediatric Surgery,2025,(02):101-108.[doi:10.3760/cma.j.cn101785-202411004-001]
Click Copy

Endovascular therapy for pediatric cerebrovascular disease: clinical advances and considerations

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: Number: 2025年02 Page: 101-108 Column: 述评 Date of publication: 2025-02-28
Author(s):
Tang Jun;  Liang Ping
Department of Neurosurgery, Affiliated Children’s Hospital, Chongqing Medical University; National Research Center for Children’s Health & Disorders, Chongqing 400014, China
Keywords:
Cerebrovascular Disease; Ischemic Stroke; Hemorrhagic Stroke; Endovascular Therapy; Child
DOI:
10.3760/cma.j.cn101785-202411004-001
Abstract:
Pediatric cerebrovascular disease (CVD) refers to a large group of diseases affecting blood vessels in brain and spinal cord of children.In recent years,there are growing attention and numerous reports on endovascular therapy (EVT) for pediatric CVD with mounting evidence demonstrating its feasibility and safety.However,there is still an acute lack of guidelines or standards for EVT in children to guide patient selection,neurointerventional material selection,surgical techniques and postoperative cares.Due to unique characteristics of pediatric population,such as smaller and more fragile blood vessels and differing causes of pediatric CVD from adults,pediatric neurosurgeons and neurointerventionists must consider differences in neurovascular characteristics,concurrent diseases,collateral vessels imaging parameters and expected outcomes.These factors may affect appropriate patient selection and surgical timing.This review summarized the latest developments in EVT for pediatric CVD through a literature review and mutiple years of experience in treating CVD.Most CVD children may benefit through establishing regional pediatric stroke teams,screening suitable pediatric patients and formulating definite treatment guidelines or standards.

References:

[1] Ferriero DM,Fullerton HJ,Bernard TJ,et al.Management of stroke in neonates and children:a scientific statement from the American Heart Association/American Stroke Association[J].Stroke,2019,50(3):e51-e96.DOI:10.1161/STR.0000000000000183.
[2] Fuentes A,Deotto A,Desrocher M,et al.Determinants of cognitive outcomes of perinatal and childhood stroke:a review[J].Child Neuropsychol,2016,22(1):1-38.DOI:10.1080/09297049.2014.969694.
[3] Fraser S,Levy SM,Moreno A,et al.Risk factors for pediatric ischemic stroke and intracranial hemorrhage:a national electronic health record based study[J].Heliyon,2024,10(10):e31124.DOI:10.1016/j.heliyon.2024.e31124.
[4] Jeong G,Lim BC,Chae JH.Pediatric stroke[J].J Korean Neurosurg Soc,2015,57(6):396-400.DOI:10.3340/jkns.2015.57.6.396.
[5] GBD 2016 Headache Collaborators.Global,regional,and national burden of migraine and tension-type headache,1990-2016:a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet Neurol,2018,17(11):954-976.DOI:10.1016/S1474-4422(18)30322-3.
[6] GBD 2019 Stroke Collaborators.Global,regional,and national burden of stroke and its risk factors,1990-2019:a systematic analysis for the Global Burden of Disease Study 2019[J].Lancet Neurol,2021,20(10):795-820.DOI:10.1016/S1474-4422(21)00252-0.
[7] Lasjaunias P,Rodesch G,Terbrugge K,et al.Vein of Galen aneurysmal malformations.report of 36 cases managed between 1982 and 1988[J].Acta Neurochir (Wien),1989,99(1/2):26-37.DOI:10.1007/BF01407773.
[8] Rodesch G,Malherbe V,Alvarez H,et al.Nongalenic cerebral arteriovenous malformations in neonates and infants.Review of 26 consecutive cases (1982-1992)[J].Childs Nerv Syst,1995,11(4):231-241.DOI:10.1007/BF00277659.
[9] Saleh E,Dawson RC3rd.Endovascular management of pediatric aneurysms[J].Neuroradiol J,2011,24(5):693-698.DOI:10.1177/197140091102400505.
[10] Gralla J,Brekenfeld C,Schmidli J,et al.Internal carotid artery aneurysm with life-threatening hemorrhages in a pediatric patient:endovascular treatment options[J].J Endovasc Ther,2004,11(6):734-738.DOI:10.1583/1308R.1.
[11] Irazuzta J,Sullivan KJ.Hyperacute therapies for childhood stroke:a case report and review of the literature[J].Neurol Res Int,2010,2010:497326.DOI:10.1155/2010/497326.
[12] Sun LR,Harrar D,Drocton G,et al.Mechanical thrombectomy for acute ischemic stroke:considerations in children[J].Stroke,2020,51(10):3174-3181.DOI:10.1161/STROKEAHA.120.029698.
[13] Winkler EA,Kim CN,Ross JM,et al.A single-cell Atlas of the normal and malformed human brain vasculature[J].Science,2022,375(6584):eabi7377.DOI:10.1126/science.abi7377.
[14] Lv XL,Jiang CH,Wang J.Pediatric intracranial arteriovenous shunts:advances in diagnosis and treatment[J].Eur J Paediatr Neurol,2020,25:29-39.DOI:10.1016/j.ejpn.2019.12.025.
[15] Suh DC,Alvarez H,Bhattacharya JJ,et al.Intracranial haemorrhage within the first two years of life[J].Acta Neurochir (Wien),2001,143(10):997-1004.DOI:10.1007/s007010170004.
[16] Engel ER,Wusik K,Bright P,et al.Prevalence and predictors of hereditary hemorrhagic telangiectasia and capillary-malformation arteriovenous malformation syndrome among children with neurovascular malformations[J].J Pediatr,2024,264:113761.DOI:10.1016/j.jpeds.2023.113761.
[17] 向永军,王杭州,杨天权,等.儿童幕上脑动静脉畸形破裂出血急性期分阶段手术的疗效分析[J].临床小儿外科杂志,2023,22(9):881-884.DOI:10.3760/cma.j.cn101785-202207045-016. Xiang YJ,Wang HZ,Yang TQ,et al.Staged surgery for supratentorial arteriovenous malformation rupture in children during acute phase[J].DOI:10.3760/cma.j.cn101785-202207045-016.
[18] White AJ,Marmor I,Peacock KM,et al.Brain abscess and stroke in children and adults with hereditary hemorrhagic telangiectasia:analysis of a large national claims database[J].Neurology,2023,100(23):e2324-e2330.DOI:10.1212/WNL.0000000000207269.
[19] See AP,Smith ER.Management of pediatric intracranial arteriovenous malformations[J].J Korean Neurosurg Soc,2024,67(3):289-298.DOI:10.3340/jkns.2024.0027.
[20] Umansky D,Corn BW,Strauss I,et al.Combined treatment approach to cerebral arteriovenous malformation in pediatric patients:stereotactic radiosurgery to partially Onyx-embolized AVM[J].Childs Nerv Syst,2018,34(11):2269-2274.DOI:10.1007/s00381-018-3854-2.
[21] Stracke CP,Schwindt W,Meyer L,et al.Endovascular treatment of spinal AVM:report of two cases with transvenous approach in combination with retrograde pressure cooker technique[J].Neuroradiology,2023,65(5):961-968.DOI:10.1007/s00234-023-03132-x.
[22] Zhang G,Zhu SY,Wu P,et al.The transvenous pressure cooker technique:a treatment for brain arteriovenous malformations[J].Interv Neuroradiol,2017,23(2):194-199.DOI:10.1177/1591019916682357.
[23] de Castro-Afonso LH,Nakiri GS,Oliveira RS,et al.Curative embolization of pediatric intracranial arteriovenous malformations using Onyx:the role of new embolization techniques on patient outcomes[J].Neuroradiology,2016,58(6):585-594.DOI:10.1007/s00234-016-1666-1.
[24] Wang A,Mandigo GK,Feldstein NA,et al.Curative treatment for low-grade arteriovenous malformations[J].J Neurointerv Surg,2020,12(1):48-54.DOI:10.1136/neurintsurg-2019-015115.
[25] Rodriguez-Calienes A,Saal-Zapata G,Borjas-Calderón NF,et al.Curative embolization for pediatric Spetzler-Martin grade III cerebral arteriovenous malformations[J].World Neurosurg,2022,160:e494-e500.DOI:10.1016/j.wneu.2022.01.051.
[26] Tang J,Li LS,Zhou YD,et al.Embolization of midbrain arteriovenous malformation fed by the artery of Percheron in a child,the first case report and literature review[J].Childs Nerv Syst,2023,39(9):2527-2532.DOI:10.1007/s00381-023-05978-1.
[27] Meling TR,Patet G.What is the best therapeutic approach to a pediatric patient with a deep-seated brain AVM?[J].Neurosurg Rev,2019,42(2):409-416.DOI:10.1007/s10143-019-01101-8.
[28] Yue JK,Chang D,Caton MTJr,et al.The hybrid operative suite with intraoperative biplane rotational angiography in pediatric cerebrovascular neurosurgery:utility and lessons learned[J].Pediatr Neurosurg,2022,57(4):245-259.DOI:10.1159/000524875.
[29] Nam SM,Jang D,Wang KC,et al.Characteristics and treatment outcome of intracranial aneurysms in children and adolescents[J].J Korean Neurosurg Soc,2019,62(5):551-560.DOI:10.3340/jkns.2019.0140.
[30] Kim M,Lee HS,Lee S,et al.Pediatric intracranial aneurysms:favorable outcomes despite rareness and complexity[J].World Neurosurg,2019,125:e1203-e1216.DOI:10.1016/j.wneu.2019.01.280.
[31] Yasin JT,Wallace AN,Madaelil TP,et al.Treatment of pediatric intracranial aneurysms:case series and meta-analysis[J].J Neurointerv Surg,2019,11(3):257-264.DOI:10.1136/neurintsurg-2018-014001.
[32] Deora H,Rao KVLN,Somanna S,et al.Surgically managed pediatric intracranial aneurysms:how different are they from adult intracranial aneurysms?[J].Pediatr Neurosurg,2017,52(5):313-317.DOI:10.1159/000477815.
[33] de Aguiar GB,Ozanne A,Elawady A,et al.Intracranial aneurysm in pediatric population:a single-center experience[J].Pediatr Neurosurg,2022,57(4):270-278.DOI:10.1159/000524523.
[34] Saraf R,Shrivastava M,Siddhartha W,et al.Intracranial pediatric aneurysms:endovascular treatment and its outcome[J].J Neurosurg Pediatr,2012,10(3):230-240.DOI:10.3171/2012.5.PEDS1210.
[35] Ostergaard JR.Aetiology of intracranial saccular aneurysms in childhood[J].Br J Neurosurg,1991,5(6):575-580.DOI:10.3109/02688699109002879.
[36] Sluzewski M,Brilstra EH,van Rooij WJ,et al.Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms[J].Neuroradiology,2001,43(4):336-341.DOI:10.1007/s002340000498.
[37] Eddleman C,Nikas D,Shaibani A,et al.HydroCoil embolization of a ruptured infectious aneurysm in a pediatric patient:case report and review of the literature[J].Childs Nerv Syst,2007,23(6):707-712.DOI:10.1007/s00381-006-0264-7.
[38] Vargas SA,Diaz C,Herrera DA,et al.Intracranial aneurysms in children:the role of stenting and Flow-Diversion[J].J Neuroimaging,2016,26(1):41-45.DOI:10.1111/jon.12305.
[39] Eraky AM,Feller C,Tolba H,et al.Flow diverter stenting for intracranial aneurysms in the pediatric population:two case reports and literature review[J].J Cerebrovasc Endovasc Neurosurg,2024,26(1):58-64.DOI:10.7461/jcen.2023.E2023.04.001.
[40] Chen K,Shi Y,Bao KY,et al.Pediatric intracranial aneurysms:endovascular treatment[J].Asian J Surg,2023,46(11):5112-5113.DOI:10.1016/j.asjsur.2023.06.100.
[41] Fry L,Brake A,Heskett CA,et al.Endovascular management of pediatric traumatic intracranial pseudoaneurysms:a systematic review and case series[J].World Neurosurg,2023,176:213-226.DOI:10.1016/j.wneu.2023.04.028.
[42] Alawi A,Edgell RC,Elbabaa SK,et al.Treatment of cerebral aneurysms in children:analysis of the Kids’ Inpatient Database[J].J Neurosurg Pediatr,2014,14(1):23-30.DOI:10.3171/2014.4.PEDS13464.
[43] Bhogal P,Pérez MA,Wendl C,et al.Paediatric aneurysms-Review of endovascular treatment strategies[J].J Clin Neurosci,2017,45:54-59.DOI:10.1016/j.jocn.2017.08.009.
[44] Saini V,Guada L,Yavagal DR.Global epidemiology of stroke and access to acute ischemic stroke interventions[J].Neurology,2021,97(20 Suppl 2):S6-S16.DOI:10.1212/WNL.0000000000012781.
[45] Lehman LL,Khoury JC,Taylor JM,et al.Pediatric stroke rates over 17 years:report from a population-based study[J].J Child Neurol,2018,33(7):463-467.DOI:10.1177/0883073818767039.
[46] Pero G,Ruggieri F,Macera A,et al.Endovascular treatment of acute ischemic stroke in childhood:a comprehensive literature review based on the experience of a single center[J].Eur J Radiol Open,2023,11:100528.DOI:10.1016/j.ejro.2023.100528.
[47] Krishnamurthi RV,deVeber G,Feigin VL,et al.Stroke prevalence,mortality and disability-adjusted life years in children and youth aged 0-19 years:data from the global and regional burden of stroke 2013[J].Neuroepidemiology,2015,45(3):177-189.DOI:10.1159/000441087.
[48] Nogueira RG,Haussen DC,Liebeskind DS,et al.Clinical effectiveness of endovascular stroke treatment in the early and extended time windows[J].Int J Stroke,2022,17(4):389-399.DOI:10.1177/17474930211005740.
[49] Powers WJ,Derdeyn CP,Biller J,et al.2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2015,46(10):3020-3035.DOI:10.1161/STR.0000000000000074.
[50] Sporns PB,Kemmling A,Lee S,et al.A prospective multicenter registry on feasibility,safety,and outcome of endovascular recanalization in childhood stroke (save ChildS pro)[J].Front Neurol,2021,12:736092.DOI:10.3389/fneur.2021.736092.
[51] Sporns PB,Str?ter R,Minnerup J,et al.Feasibility,safety,and outcome of endovascular recanalization in childhood stroke:the save ChildS study[J].JAMA Neurol,2020,77(1):25-34.DOI:10.1001/jamaneurol.2019.3403.
[52] Bhatia K,Kortman H,Blair C,et al.Mechanical thrombectomy in pediatric stroke:systematic review,individual patient data meta-analysis,and case series[J].J Neurosurg Pediatr,2019,24(5):558-571.DOI:10.3171/2019.5.PEDS19126.
[53] Satti S,Chen J,Sivapatham T,et al.Mechanical thrombectomy for pediatric acute ischemic stroke:review of the literature[J].J Neurointerv Surg,2017,9(8):732-737.DOI:10.1136/neurintsurg-2016-012320.
[54] Cobb MIPH,Laarakker AS,Gonzalez LF,et al.Endovascular therapies for acute ischemic stroke in children[J].Stroke,2017,48(7):2026-2030.DOI:10.1161/STROKEAHA.117.016887.
[55] Flores-Milan G,Rainone GJ,Peto I,et al.Timing of embolization,radiosurgery,and resection of arteriovenous malformations in pediatric patients:a retrospective,descriptive study[J].World Neurosurg,2024,190:e488-e495.DOI:10.1016/j.wneu.2024.07.161.
[56] Blauwblomme T,Bourgeois M,Meyer P,et al.Long-term outcome of 106 consecutive pediatric ruptured brain arteriovenous malformations after combined treatment[J].Stroke,2014,45(6):1664-1671.DOI:10.1161/STROKEAHA.113.004292.
[57] Deng ZH,Chen Y,Ma L,et al.Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection:a single-center experience[J].Neurosurg Rev,2021,44(2):915-923.DOI:10.1007/s10143-019-01210-4.
[58] Iv M,Choudhri O,Dodd RL,et al.High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations[J].J Neurosurg Pediatr,2018,22(3):251-260.DOI:10.3171/2018.3.PEDS17723.
[59] López álvarez JM,Pérez Quevedo O,Santana Cabrera L,et al.Vascular ultrasound in pediatrics:estimation of depth and diameter of jugular and femoral vessels[J].J Ultrasound,2017,20(4):285-292.DOI:10.1007/s40477-017-0272-3.
[60] Colby GP,Jiang BW,Bender MT,et al.Pipeline-assisted coil embolization of a large middle cerebral artery pseudoaneurysm in a 9-month-old infant:experience from the youngest flow diversion case[J].J Neurosurg Pediatr,2018,22(5):532-540.DOI:10.3171/2018.6.PEDS18165.
[61] Cobb MIPH,Zomorodi AR,Hauck EF,et al.Optimal pediatric dosing of anti-platelet agents for pipeline stent embolization-a case report and review of the literature[J].Childs Nerv Syst,2017,33(4):685-690.DOI:10.1007/s00381-016-3311-z.
[62] Nogueira RG,Jadhav AP,Haussen DC,et al.Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J].N Engl J Med,2018,378(1):11-21.DOI:10.1056/NEJMoa1706442.
[63] Lee S,Heit JJ,Albers GW,et al.Neuroimaging selection for thrombectomy in pediatric stroke:a single-center experience[J].J Neurointerv Surg,2019,11(9):940-946.DOI:10.1136/neurintsurg-2019-014862.
[64] Wilkinson DA,Pandey AS,Garton HJ,et al.Late recanalization of basilar artery occlusion in a previously healthy 17-month-old child[J].J Neurointerv Surg,2018,10(7):e17.DOI:10.1136/neurintsurg-2017-013277.rep.
[65] Sporns PB,Psychogios MN,Straeter R,et al.Clinical diffusion mismatch to select pediatric patients for embolectomy 6 to 24 hours after stroke:an analysis of the save ChildS study[J].Neurology,2021,96(3):e343-e351.DOI:10.1212/WNL.0000000000011107.

Memo

收稿日期:2024-11-1。
基金项目:重庆市教委重点项目(KJ2024004109887015)
通讯作者:梁平,Email:liangping868@sina.com

Last Update: 2025-02-28