Arterial Ischemic Stroke (AIS) in pediatric patients is a rare condition. The incidence of pediatric stroke is 1.6-2.4/100,000 children/year. The etiology differs from adults, with more cases attributed to vasculitis, cardio-embolism, trauma, and genetic conditions. The reported mortality rates vary from six to thirty percent, which may also impair cognitive and neuropsychological development. In our case, the 6-year-old child presented 12 hours after the neurological baseline. Imaging showed large infarcts in bilateral cerebellar hemispheres and small infarcts in pons, right thalamus, and splenium. Mechanical thrombectomy with Solitaire stent retriever was done with an onset to revascularization time of 14 hours. The child had an uneventful postprocedure course with mrs 3. Our case adds to the limited data on the use of mechanical thrombectomy in pediatric large vessel occlusion stroke beyond the six-hour window. Pediatric stroke is a devastating condition affecting the development and functioning of the child and may be treated in the thrombectomy era. Pediatric basilar artery occlusion patients presenting beyond six hours form a separate subset of stroke cases and require separate guidelines for mechanical thrombectomy. This extended window’s guidelines should probably be based on the pc-aspects.

Ariharan K is an Interventional Neuroradiologist currently working in the Department of Interventional Radiology at Father Muller Medical College, Mangalore, India. He completed his DM in Neuroimaging and Interventional Radiology and MD in Radiodiagnosis from JIPMER, Puducherry. His Clinical and academic interests focus on neurovascular interventions, with particular expertise in mechanical thrombectomy for acute ischemic stroke and carotid interventions. He has authored multiple publications in indexed national and international journals, including Neurology India and the Journal of NeuroInterventional Surgery (JNIS). He has been invited as faculty at national scientific meetings such as Endovascular Live 2025 and the ISNR Midterm CME, and is a lifetime member of ISNR, ISVIR, and IRIA. His academic excellence is reflected in his gold medals in Ophthalmology (2012) and Radiodiagnosis (2018).