A Child with Paradoxical Cerebral Embolism in Whom Mechanical Thrombectomy Led to a Favorable Outcome

Abstract

Objective: We report a case of paradoxical cerebral embolism caused by patent foramen ovale (PFO) that was treated by the direct aspiration first pass technique (ADAPT).

Case presentation: The case involved a 12-year-old boy who had symptoms of dizziness and vomiting the day prior to being admitted to the emergency department. The following morning, consciousness disorder, dysarthria, and right paresis were observed, and he was transferred to our hospital. Computed tomography (CT) and magnetic resonance imaging (MRI) lead to the diagnosis of acute cerebral infarction due to basilar artery (BA) occlusion. Mechanical thrombectomy was performed, and Thrombolysis in Cerebral Infarction (TICI) 3 was obtained. Postoperatively, his consciousness was improved, but echocardiography revealed PFO. Percutaneous PFO closure was performed at our department of pediatric cardiology.

Conclusion: For our patient with paradoxical cerebral embolism of the BA caused by PFO more than 6 hours after onset, mechanical thrombectomy with ADAPT using a Penumbra 5MAX ACE68 resulted in a good outcome.

Keywords: basilar artery occlusion; mechanical thrombectomy; pediatric acute ischemic stroke.