Background: Direct aspiration as a first-pass technique (ADAPT) and combined stent-retrieval and aspiration (CSRA) are well-established techniques for endovascular thrombectomy (EVT) in adult large-vessel occlusion (LVO) stroke. However, data on their application in pediatric populations remain limited. Case Description: We report a case of a 2 years old treated with ADAPT for LVO and conducted a systematic review of all reported pediatric cases using aspiration-based EVT (ADAPT or CSRA) through April 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Including our case, 64 pediatric patients from 37 studies were analyzed. ADAPT was used in 29 (45.3%) patients, CSRA in 32 (50.0%), and 3 (4.7%) initially attempted ADAPT but required stent retrieval. Mean age was 9.8 years (standard deviation 5.8); 40.4% were female. Etiologies included cardioembolic (41.3%), idiopathic (34.8%), and others. ADAPT was more common in patients with cardiac conditions ( P = 0.026). Recanalization (thrombolysis in cerebral infarction ≥2b) was achieved in 92.6%, with no significant difference in outcomes between techniques. Mortality was 3.1%. Conclusion: ADAPT and CSRA are feasible and effective techniques for EVT in pediatric LVO, with high rates of recanalization and favorable outcomes across a broad range of ages and etiologies. Differences between techniques were minimal, except that ADAPT was significantly more likely to be used in patients with underlying cardiac conditions.
White et al. (Fri,) studied this question.