Pediatric Stroke: Endovascular Intervention is Revolutionizing Care

By the time Rafael Sillero, M.D., came to UT Southwestern for a neuroradiology fellowship, he had completed a residency in neurosurgery and a clinical research fellowship in pediatric neurosurgery. But he didn’t aim to spend his career in pediatrics until his own two kids were diagnosed with a genetic hearing disorder and treated at Children’s Health℠, Children’s Medical Center Dallas. 

“I saw how important it is for families to have access to specialists who understand kids and know how to tailor treatment to them,” Dr. Sillero says. “That made me decide to shift my career and add a pediatric neurosurgery fellowship.”

Dr. Sillero, Pediatric Neurosurgeon at Children’s Health and Assistant Professor of Neurological Surgery at UT Southwestern, has unique, dual expertise in neurosurgery and interventional neuroradiology – he’s among a small handful of physicians who have experience applying techniques like endovascular embolization to children – expands Children’s Health’s ability to help kids overcome stroke and many other conditions.

“Dr. Sillero’s unique blend of skills enables us to offer the latest, minimally invasive endovascular techniques,” says Bradley Weprin, M.D., who directs Children’s Health’s neurosurgery division. “We’re ecstatic to have him on board.”

Using Catheters to Break Through Blockages

Dr. Weprin is especially excited about the potential of endovascular interventions to improve treatment for ischemic and hemorrhagic strokes.

For ischemic strokes, anticoagulants have been standard treatment, with clot-busting drugs like TPA available in some cases. Surgeons can also use vascular bypass grafting to go around the blockage and restore blood flow.

Now Dr. Sillero can use a catheterization procedure to break through the blockage.

“Children’s blood vessels have often been considered too small for endovascular procedures, but the new generation of catheterization devices and techniques changes the equation,” he says.

This approach is ideal for patients with smaller, non-complex blockages or for blockages that have already ruptured. Most patients go home within a day or two.

One consideration is that this procedure does require significant follow up via MRI to ensure the blockage does not become an issue in the future. This can expose children to anesthesia and the associated potential risks.

Open surgery is still the ideal treatment for larger, complex cases as it is ‘final’ and requires no MRI follow-up,” Dr. Sillero says, “but interventional procedures can be similarly effective in some cases, without open surgery’s risks or recovery times.”

Solving Aneurysms Without Open Surgery

The same principle applies to hemorrhagic strokes. In the past, the primary surgical options were to clip off aneurysms, or bypass blood vessels that were broken or vulnerable. Dr. Sillero has extensive training in a new option called endovascular coiling, which uses a catheter to release tiny platinum coils into the area around the aneurysm.

“It induces clotting and is very effective at stopping blood from getting into an aneurysm that has broken or has the potential to do so,” Dr. Sillero says.

Tailoring Care to Each Child

Most children who suffer a stroke are quickly sent to adult centers that might not be experienced with kids. The Children’s Health team has the expertise to match each child with the most appropriate intervention, and to deliver treatment in the most effective way possible.

“Because we have such a broad skillset, we’re not wedded to a particular approach – we can decide what’s right for each child that comes through our doors,” Dr. Sillero says. “That means that we can give every patient the best chance at a good outcome, whether they need surgery, an interventional procedure or something else entirely.”

Learn more about the innovations happening in the neurosurgery division at Children’s Health. 

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