ISC 2026 | Debate at ISC 2026: thrombectomy in pediatric large vessel occlusion

In comparison to adults, we don’t have a lot of randomized prospective controlled trials to really support performing thrombectomy in children. However, there have been a few landmark papers. The major one that I discussed was by Bhatia and his group in 2022, last summer actually, where they looked at a case control cohort of patients who had a large vessel occlusion who underwent thrombectomy, and then they compared it to children who had a large vessel occlusion who only received medical management. And what they found is that the outcomes for the entire patient group, which was ages one through 18, was superior to medical management. So although we don’t have a lot of level one evidence, we do have papers that support the level one evidence for the standard of care for stroke with a large vessel occlusion, like in adults, that support the fact that it’s very helpful. So it’s funny because I kind of felt like his talk was more supportive of my talk, which was saying no age limit. He did point out some very interesting things. And I think at the conclusion of the talk, we decided that we shouldn’t say age, we should say size. When it comes to small, tiny children, the devices that are currently used in order to take the clot out of the brain, they may not fit. They are not optimized for the pediatric population. They haven’t been made for the pediatric population or tested. But, however, what we’re doing is we’re utilizing a lot of the devices that we’re using in adults for children. So that’s basically the one limitation that you have. The one major limitation that you have is that the sizing may not work. The other argument that he was giving is that there are certain strokes that you just can’t treat for children because it’s not really a large vessel occlusion but of course our debate was on large vessel occlusion. And so again I think at the end of the day he was in agreement with me that it’s not really an age it’s by size and if the patient has an opportunity to undergo the procedure by experienced individuals then they should probably have the procedure. My major discussion was that every patient that enters into the emergency room with a large vessel occlusion, it should not be decided by age or race or gender whether they should get the procedure or not. It should be based on what is their condition, what does the imaging look like, and if you have the expertise to perform the procedure, you should do the procedure because mechanical thrombectomy truly is the standard of care for large vessel occlusion.

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