Acute Ischemic Stroke in Pediatric Patients Aged 28 Days to 18 Years: Reperfusion in Disabling Deficits and Large Vessel Occlusion

Confirmed acute ischemic stroke in children and adolescents — from neonates beyond the newborn period through age 18 — presents specific management decisions depending on deficit severity and vascular anatomy. This protocol addresses the acute reperfusion step in this age group.

Clinical Scenario

Pediatric patient aged 28 days to 18 years with confirmed acute ischemic stroke presenting with disabling neurological deficits, or with stroke attributable to large vessel occlusion. Both presentations define distinct eligibility pathways within this protocol.

Treatment Approach (partial overview)

Depending on time from symptom onset and clinical presentation, this protocol involves either intravenous thrombolysis or endovascular thrombectomy — with specific eligibility thresholds, age sub-criteria, and operator requirements that differ between the two interventions.

Full eligibility criteria, intervention selection logic, and the structured regimen are available in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/STR.0000000000000513

In pediatric patients aged 28 days to 18 years with confirmed AIS presenting within 4.5 hours of symptom onset and disabling deficits, IVT with alteplase may be considered as it is safe, but efficacy is uncertain.

In pediatric patients ≥6 years with acute neurological symptoms and ischemic stroke due to LVO and within 6 hours from symptom onset, EVT can be effective if performed by experienced neurointerventionalists to improve functional outcomes.

In pediatric patients ≥6 years with acute neurological symptoms and ischemic stroke due to LVO, 6 to 24 hours from symptom onset, and with potentially salvageable brain tissue, EVT can be effective to improve functional outcomes.

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