Case Report: Multidisciplinary and individualized management of periprocedural arterial thrombosis and ischemic stroke in children: a three-case series

Pediatric arterial thromboembolism is rare but may cause limb loss, extensive cerebral infarction, permanent disability, or death. Evidence guiding reperfusion therapy in children remains limited. We describe three periprocedural events treated according to their vascular territory, threatened tissue, and bleeding risk. A male neonate born at 37 weeks’ gestation developed catheter-associated left external iliac–femoral arterial thrombosis after umbilical arterial catheterization during treatment for shock and respiratory illness. Intravenous urokinase and low-molecular-weight heparin achieved complete thrombus resolution on ultrasonography six days after diagnosis. A 5-year-and-5-month-old boy developed acute left internal carotid–middle cerebral artery occlusion with extensive left hemispheric infarction three days after thoracoscopic resection of pulmonary sequestration. Emergency stent-retriever thrombectomy with aspiration achieved immediate recanalization, which persisted at one week; independent ambulation was restored after rehabilitation, although mild right upper-limb symptoms remained at discharge. A 4-month-old boy developed right frontotemporal–insular ischemic infarction after balloon angioplasty for recurrent aortic coarctation. Because no retrievable intracranial large-vessel occlusion was identified and the recent cardiac intervention increased the bleeding risk, aspirin, low-molecular-weight heparin, and supportive treatment were administered. Follow-up MRI one week after diagnosis showed regression of the initial lesion but revealed a new right thalamic lesion suspicious for acute infarction. These heterogeneous cases highlight the need for prompt vascular imaging and individualized multidisciplinary management based on the vascular territory, threatened tissue, patient size, recent procedures, bleeding risk, and procedural feasibility. As a descriptive case series, this report does not establish the comparative efficacy of the treatment strategies.