Endovascular therapeutic occlusion of major cerebral arteries in children

Abstract

Background

Therapeutic occlusion of major cerebral arteries is sometimes required in pediatric cerebrovascular conditions of the head and neck. However, this procedure carries a considerable risk of stroke and de novo intracranial aneurysm formation. This study aims to assess the long-term clinical and radiographic outcomes of therapeutic cerebral artery occlusion in a pediatric cohort.

Methods

A retrospective review was conducted on pediatric patients who underwent endovascular therapeutic occlusion between January 2002 and June 2023. Clinical presentation, radiographic findings, management strategies, and follow-up data were analyzed.

Results

Eighteen children (male-to-female ratio: 2:1, mean age: 8.8 years) were included. Most cases (83%) were symptomatic at presentation. The diagnoses included aneurysm (44.4%), arterial dissection (22.2%), arteriovenous shunting (22.2%), and craniocervical neoplasm (11.1%). Eight patients underwent carotid circulation occlusion, and 10 underwent vertebrobasilar system occlusions; the majority (77.7%) were performed electively. Detachable coils were the primary devices used. Complete occlusion was observed in 89.9% of cases on immediate control angiography, and repeat embolization was performed in 2 cases. Perioperative ischemic strokes were observed in five cases: three asymptomatic and two with mild symptoms that completely resolved on follow-up. No new infarcts, transient ischemic attacks, de novo intracranial aneurysms, or mortality were observed over a mean clinical and radiographic follow-up duration of 6.9 years and 4 years, respectively.

Conclusions

Therapeutic occlusion of major cerebral arteries appears to be a safe and effective treatment in pediatric patients. Nevertheless, long-term follow-up is recommended due to the theoretical risk of de novo aneurysm formation over their lifespan.