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Introduction Acute ischemic stroke (AIS) in children is traditionally regarded as a rare condition; however, it represents a significant cause of neurological morbidity in neonates and children if untreated, with serious neurological sequelae or fatal outcome.Mechanical thrombectomy is the standard of care for large vessel occlusion (LVO) in adults. However, there are currently no randomized controlled trials evaluating its efficacy and safety in the pediatric population.Aim of Study The aim of this study is to present two cases of pediatric anterior and posterior circulation stroke in preadolescent children, treated at the Clinical Center of the University of Sarajevo, with an emphasis on the treatment techniques employed and a review of current concepts and recommendationsMethod A retrospective review was conducted of consecutive pediatric thrombectomy cases in preadolescent children between 2023 and 2024 at the Clinical Center of the University of Sarajevo. Demographic characteristics, imaging findings, technical details of the procedures, and clinical outcomes were systematically recorded.Abstract A313 Figure 1Results Preadolescent children with AIS due to eLVO of anterior and posterior circulations were subject to mechanical thrombectomy with median age of 6.0 (5–7) and Ped-NIHSS 19 (18–20), both with good recanalization (TICI 2b/3). Median time from onset of the symptoms to groin puncture was 8h22min (4h45 min-11h58min). At the discharge both children were independent (mRS≤2).Abstract A313 Figure 2Conclusion Endovascular treatment of acute ischemic stroke can be performed safely in selected pediatric patients, despite inherent challenges related to atypical clinical presentations and the current lack of robust evidence-based data supporting acute recanalization therapies.Conflict of Interest No