Abstract
BackgroundTherapeutic occlusion of major cerebral arteries is sometimes required in pediatric cerebrovascular conditions of the head and neck. However, this procedure carries a considerable risk of stroke and de novo intracranial aneurysm formation. This study aims to assess the long-term clinical and radiographic outcomes of therapeutic cerebral artery occlusion in a pediatric cohort.MethodsA retrospective review was conducted on pediatric patients who underwent endovascular therapeutic occlusion between January 2002 and June 2023. Clinical presentation, radiographic findings, management strategies, and follow-up data were analyzed.ResultsEighteen children (male-to-female ratio: 2:1, mean age: 8.8 years) were included. Most cases (83%) were symptomatic at presentation. The diagnoses included aneurysm (44.4%), arterial dissection (22.2%), arteriovenous shunting (22.2%), and craniocervical neoplasm (11.1%). Eight patients underwent carotid circulation occlusion, and 10 underwent vertebrobasilar system occlusions; the majority (77.7%) were performed electively. Detachable coils were the primary devices used. Complete occlusion was observed in 89.9% of cases on immediate control angiography, and repeat embolization was performed in 2 cases. Perioperative ischemic strokes were observed in five cases: three asymptomatic and two with mild symptoms that completely resolved on follow-up. No new infarcts, transient ischemic attacks, de novo intracranial aneurysms, or mortality were observed over a mean clinical and radiographic follow-up duration of 6.9 years and 4 years, respectively.ConclusionsTherapeutic occlusion of major cerebral arteries appears to be a safe and effective treatment in pediatric patients. Nevertheless, long-term follow-up is recommended due to the theoretical risk of de novo aneurysm formation over their lifespan.