Fibrin-Heparin-Coated Intracranial Stents as Salvage Therapy in Pediatric Focal Cerebral Arteriopathy of Inflammatory Type

Arterial ischemic stroke (AIS) in children is frequently associated with underlying arteriopathy. We report a 13-year-old male with progressive AIS due to focal cerebral arteriopathy of inflammatory type (FCA-i). Despite initial medical therapy-including antiplatelet agents, immunosuppressive therapy, antimicrobial treatment, and intra-arterial spasmolysis-he experienced clinical and radiographic deterioration. Endovascular therapy with balloon angioplasty and fibrin-heparin-coated intracranial stents achieved successful revascularization and stabilization. Vessel wall MRI and elevated Mycoplasma pneumoniae antibodies supported the diagnosis of FCA-i. Follow-up demonstrated sustained stent patency and vascular improvement, with persistent distal upper-extremity-predominant hemiparesis.