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Updated: Mar 1, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Regional Pediatric Acute Stroke Protocol: Initial Experience During 3 Years and 13 Recanalization Treatments in
Laurence Tabone1, Nicolas Mediamolle1, Celine Bellesme1
1From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N) and Department of Neurology (C.L.), INSERM UMR-S894, Université Paris-Descartes, Sainte-Anne Hospital, France.
Insights
Establishing a pediatric stroke alert protocol enabled feasible and safe hyperacute recanalization treatments for pediatric arterial ischemic stroke, showing favorable outcomes in most survivors.
Area of Science:
- Pediatric Neurology
- Stroke Medicine
- Emergency Medicine
Background:
- Dedicated management pathways are crucial for evaluating hyperacute treatments in pediatric arterial ischemic stroke.
- A regional pediatric stroke alert protocol was established across two centers in the Paris-Ile-de-France area.
Purpose of the Study:
- To evaluate the feasibility and safety of hyperacute management for pediatric arterial ischemic stroke.
- To assess the effectiveness of a regional pediatric stroke alert protocol.
Main Methods:
- Retrospective review of consecutive pediatric patients (28 days-18 years) with arterial ischemic stroke treated with acute recanalization therapies.
- Analysis of treatments including intravenous recombinant tissue-type plasminogen activator (r-tPA) and/or endovascular procedures within a 40-month period.
Main Results:
- Thirteen children received recanalization treatment; 9 had large-vessel occlusion.
- Intravenous r-tPA was administered to 11 patients, with a median treatment time of 240 minutes.
- No bleeding complications were reported; 11 of 12 survivors had favorable outcomes (modified Rankin Scale score 0-2).
Conclusions:
- Hyperacute recanalization treatment for pediatric stroke is feasible using established protocols and inter-departmental collaboration.
- Further systematic data collection is recommended to support these findings.
Background And Purpose:
To evaluate hyperacute management of pediatric arterial ischemic stroke, setting up dedicated management pathways is the first recommended step to prove the feasibility and safety of such treatments. A regional pediatric stroke alert protocol including 2 centers in the Paris-Ile-de-France area, France, was established.
Methods:
Consecutive pediatric patients (28 days-18 years) with confirmed arterial ischemic stroke who had acute recanalization treatment (intravenous r-tPA [recombinant tissue-type plasminogen activator], endovascular procedure, or both) according to the regional pediatric stroke alert were retrospectively reviewed during a 40-month period.
Results:
Thirteen children, aged 3.7 to 16.6 years, had recanalization treatment. Median time from onset to magnetic resonance imaging was 165 minutes (150-300); 9 out of 13 had large-vessel occlusion. Intravenous r-tPA was used in 11 out of 13 patients, with median time from onset to treatment of 240 minutes (178-270). Endovascular procedure was performed in patients time-out for intravenous r-tPA (n=2) or after intravenous r-tPA inefficiency (n=2). No intracranial or peripheral bleeding was reported. One patient died of malignant stroke; outcome was favorable in 11 out of 12 survivors (modified Rankin Scale score 0-2).
Conclusions:
Hyperacute recanalization treatment in pediatric stroke, relying on common protocols and adult/pediatric ward collaboration, is feasible. Larger systematic case collection is encouraged.
