Publication: Endovascular treatment of stroke in children under 2 years with heart failure and ventricular assist device.
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Date
2019-05-09
Authors
Jiménez Gómez, Elvira
Bravo Rey, Isabel
Oteros Fernández, Rafael
Delgado Acosta, Fernando
Advisors
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Abstract
Strokes in children are characterised by a high mortality rate while, at the same time, the low number of cases makes it difficult to gain practical experience. As heart disease is the most common risk factor, and as more and more cardiological interventions are being carried out, an increase in the incidence of paediatric stroke is expected. In some cases a transplant is required. While waiting for a donor, the use of ventricular assist devices may be necessary. These present with a high rate of neurological complications. We present two cases of children under 2 years of age awaiting heart transplantation supported by ventricular assist devices who had a stroke which was treated by endovascular techniques. Case 1: A 16-month-old boy with restrictive cardiomyopathy who was listed for a cardiac transplant. At 20 months he required an implantation of an external biventricular support device (Berlin Heart) and had a left hemisphere stroke at 23 months. An intra-arterial approach was used and produced good clinical results. One month later, a heart transplant was performed successfully. Case 2: An 18-month-old girl with non-compacted dilated cardiomyopathy included in the cardiac transplant programme and in need of a Levitronix Centrimag ventricular assist device presented with an acute left hemisphere stroke at 23 months. An intra-arterial procedure was carried out leading to positive clinical results except for residual right hypertonia. Seven months later she received her transplant. As a result of the difficulty in performing arterial puncture, the small vessel calibre and the limitation in the use of iodated contrast, there are certain limitations to endovascular treatment of strokes in children that can lead to complications. A multidisciplinary approach to managing such cases would be helpful.
Description
MeSH Terms
Cardiomyopathy, Dilated
Cardiomyopathy, Restrictive
Cerebral Angiography
Endovascular Procedures
Female
Follow-Up Studies
Heart Failure
Heart Transplantation
Heart-Assist Devices
Humans
Infant
Male
Middle Cerebral Artery
Retrospective Studies
Stroke
Treatment Outcome
Cardiomyopathy, Restrictive
Cerebral Angiography
Endovascular Procedures
Female
Follow-Up Studies
Heart Failure
Heart Transplantation
Heart-Assist Devices
Humans
Infant
Male
Middle Cerebral Artery
Retrospective Studies
Stroke
Treatment Outcome
DeCS Terms
CIE Terms
Keywords
Paediatric stroke, endovascular treatment, ventricular assist device