Lucy He1, Travis R Ladner2, Sumit Pruthi3, Matthew A Day3, Aditi A Desai3, Lori C Jordan4, Michael T Froehler5. 1. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA Cerebrovascular Program, Departments of Neurology and Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 2. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA Vanderbilt School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 3. Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 4. Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 5. Cerebrovascular Program, Departments of Neurology and Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Abstract
BACKGROUND AND PURPOSE: The safety of using adult-sized neuroendovascular devices in the smaller pediatric vasculature is not known. In this study we measure vessel diameters in the cervical and cranial circulation in children to characterize when adult-approved devices might be compatible in children. METHODS: For 54 children without vasculopathy (mean age 9.5±4.9 years (range 0.02-17.8), 20F/34M) undergoing catheter angiography, the diameters of the large vessels in the cervical and cranial circulation (10 locations, 611 total measurements) were assessed by three radiologists. Mean±SD diameter was calculated for the following age groups: 0-6 months, 1, 2, 3, 4, 5-9, 10-14, and 15-18 years. To compare with adult sizes, each vessel measurement was normalized to the respective region mean diameter in the oldest age group (15-18 years). Normalized measurements were compared with age and fitted to a segmented regression. RESULTS: Vessel diameters increased rapidly from 0 to 5 years of age (slope=0.069/year) but changed minimally beyond that (slope=0.005/year) (R(2)=0.2). The regression model calculated that, at 5 years of age, vessels would be 94% of the diameter of the oldest age group (compared with 59% at birth). In addition, most vessels in children under 5, while smaller, were still potentially large enough to be compatible with many adult devices. CONCLUSIONS: The growth curve of the cervicocerebral vasculature displays rapid growth until age 5, at which point most children's vessels are nearly adult size. By age 5, most neuroendovascular devices are size-compatible, including thrombectomy devices for stroke. Under 5 years of age, some devices might still be compatible. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND AND PURPOSE: The safety of using adult-sized neuroendovascular devices in the smaller pediatric vasculature is not known. In this study we measure vessel diameters in the cervical and cranial circulation in children to characterize when adult-approved devices might be compatible in children. METHODS: For 54 children without vasculopathy (mean age 9.5±4.9 years (range 0.02-17.8), 20F/34M) undergoing catheter angiography, the diameters of the large vessels in the cervical and cranial circulation (10 locations, 611 total measurements) were assessed by three radiologists. Mean±SD diameter was calculated for the following age groups: 0-6 months, 1, 2, 3, 4, 5-9, 10-14, and 15-18 years. To compare with adult sizes, each vessel measurement was normalized to the respective region mean diameter in the oldest age group (15-18 years). Normalized measurements were compared with age and fitted to a segmented regression. RESULTS: Vessel diameters increased rapidly from 0 to 5 years of age (slope=0.069/year) but changed minimally beyond that (slope=0.005/year) (R(2)=0.2). The regression model calculated that, at 5 years of age, vessels would be 94% of the diameter of the oldest age group (compared with 59% at birth). In addition, most vessels in children under 5, while smaller, were still potentially large enough to be compatible with many adult devices. CONCLUSIONS: The growth curve of the cervicocerebral vasculature displays rapid growth until age 5, at which point most children's vessels are nearly adult size. By age 5, most neuroendovascular devices are size-compatible, including thrombectomy devices for stroke. Under 5 years of age, some devices might still be compatible. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Jonathan Lena; Ramin Eskandari; Libby Infinger; Kyle M Fargen; Alejandro Spiotta; Aquilla Turk; Raymond D Turner; Imran Chaudry Journal: BMJ Case Rep Date: 2016-04-11
Authors: Justin Schwarz; Ali Al Balushi; Sri Sundararajan; Marc Dinkin; Cristiano Oliveira; Jeffrey P Greenfield; Athos Patsalides Journal: Interv Neuroradiol Date: 2020-11-25 Impact factor: 1.610
Authors: Pervinder Bhogal; Victoria Hellstern; Muhammad AlMatter; Oliver Ganslandt; Hansjörg Bäzner; Marta Aguilar Pérez; Hans Henkes Journal: Stroke Vasc Neurol Date: 2018-11-12