PAEDIATRIC NEURORADIOLOGY Primary endovascular treatment for acute ischemic stroke in teenage patients: a short case series Carmen Parra-Fariñas 1,2,3 & Adam A. Dmytriw 3 & Ignacio Delgado-Álvarez 4 & Ángel Sánchez-Montánez 4 & Maria Angeles de Miquel 5 & Teresa Sola 6 & Ana Felipe-Rucián 7 & Alfons Macaya 7 & Alejandro Tomasello 8 & Marc Ribó 2,9 & Élida Vázquez-Méndez 4 Received: 31 January 2020 /Accepted: 26 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Purpose To analyze the safety and efficacy of primary endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients younger than 18 years of age. Methods Review of 4 patients < 18 years of age with AIS, prospectively enrolled in an electronic database registry for acute ischemic stroke patients who underwent thrombectomy at tertiary centers, from January 2011 to February 2017. Clinical and imaging data were analyzed. Results All patients were female. Patients 1 to 4 were 14, 13, 16, and 13 years old, respectively. Patients 1 and 3 had left middle cerebral artery occlusion, patient 2 basilar occlusion, and patient 4 right tandem occlusion. Mean NIHSS score was 13 (7–19) on arrival and 4 (0–5) at 24 h. Patient 2 had Osler–Weber–Rendu disease and patient 4 a previously surgically repaired complete atrioventricular canal. All patients presented with clinical–radiological mismatch. CT/CTA was used in patients 1 and 4 and MRI/ MRA in patients 2 and 3. Stent retriever was used in 3 patients (patients 1, 3, and 4) and direct aspiration first-pass technique in 1 (patient 2). All 4 procedures resulted in successful recanalization and 3-month functional independence. Conclusion Primary EVT is reported in patients 13 to 16 years of age with AIS due to large vessel occlusion and clinical– radiological mismatch. Procedures were safe and effective with prompt recanalization and good clinical outcome. Keywords Teenage patients . Acute ischemic stroke . Endovascular treatment . Mechanical thrombectomy Introduction Acute ischemic stroke (AIS) is an increasingly recognized cause of mortality and morbidity in childhood, with an annual incidence of 0.6 to 6.4 cases per 100,000 children per year [1–4]. Of children with ischemic stroke, 1% currently undergo endovascular therapy [1]. Pediatric stroke may be difficult to diagnose due to atypical presentation and inconsistent imag- ing. Initial signs and symptoms may lack specificity and sim- ulate the features of other neurological diseases or conditions CP-F, ID-Á, AT and MR contributed equally to this work. * Carmen Parra-Fariñas carmenparrafarinas@gmail.com 1 Department of Radiology, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain 2 Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain 3 Department of Medical Imaging, St. Michael’ s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada 4 Diagnostic Neuroradiology Section, Department of Pediatric Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain 5 Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari de Bellvitge, L ’Hospitalet de Llobregat, Barcelona, Spain 6 Interventional Neuroradiology Section, Department of Radiology, Hospital Sant Joan de Deu, HM Delfos, Barcelona, Spain 7 Department of Pediatric Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain 8 Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain 9 Stroke Unit, Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain Neuroradiology https://doi.org/10.1007/s00234-020-02421-z