To report our cohort of children on Mechanical Circulatory Support (MCS) who suffered acute ischemic stroke (AIS), and describe treatment and outcomes in this population.

A total of 35/207 (16.9%) patients had an AIS while on MCS. MCS patients were younger and more likely to have congenital or acquired heart disease than non-MCS patients. Stroke symptoms were detected upon weaning sedation in the majority of MCS patients (37.1%), and clinical exam was confounded by paralysis or sedation in 82.9%.  Over half of MCS patients had peri-procedural strokes, and stroke was detected within 24 hours in 45.8%. Large Vessel Occlusion (LVO) was detected in over half of MCS patients; however, less than a third underwent vessel imaging as part of their initial neuroimaging. Intravenous thrombolysis was contraindicated in all MCS patients. Thrombectomy was performed on 2 MCS patients after ECMO decannulation and was not pursued for most MCS-LVO patients primarily due to large core or completed stroke (Figure 1). Mortality and morbidity were high in the MCS cohort, with 45.5% of MCS patients having an mRS of 5-6 on discharge (14.4% of non-MCS patients).

Pediatric AIS on MCS carries high morbidity and mortality and can be challenging to recognize acutely, with the post-procedural period being high-risk. Advanced neuroimaging and neuromonitoring may play an important role in earlier detection of stroke and eligibility for thrombectomy.