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Feasibility, safety, and outcome of recanalization treatment in childhood stroke

Sandra Bigi1, Andrea Dulcey1, Jan Gralla2

  • 1Department of Pediatrics, Division of Child Neurology, University Children's Hospital Bern, University of Bern, Bern.

Annals of Neurology
|April 22, 2018
PubMed

Insights

Intravenous thrombolysis and endovascular therapy (IVT/EVT) are feasible and safe for children with severe arterial ischemic stroke (AIS). Further research is needed to confirm the efficacy of these treatments in pediatric populations.

Area of Science:

  • Neurology
  • Pediatric Stroke
  • Vascular Neurology

Background:

  • Intravenous thrombolysis and endovascular therapy (IVT/EVT) are established treatments for adult arterial ischemic stroke (AIS).
  • Evidence from randomized controlled trials is lacking for pediatric AIS patients.
  • This study investigates the feasibility, safety, and outcomes of IVT/EVT in children.

Purpose of the Study:

  • To evaluate the feasibility and safety of IVT/EVT in pediatric patients with AIS.
  • To compare outcomes of IVT/EVT with standard care (SC) in this population.
  • To identify factors associated with outcomes in pediatric AIS.

Main Methods:

  • Retrospective, multicenter cohort study (2000-2015) of patients aged 1 month to 16 years with AIS and pediatric National Institutes of Health Stroke Scale (pedNIHSS) ≥ 4.
  • Comparison of patients receiving IVT/EVT with those receiving SC using adjusted linear regression.
  • Outcome assessment at 6 months using the pediatric stroke outcome measure (PSOM).

Main Results:

  • 150 patients were included; 16 (11%) received IVT/EVT.
  • Patients receiving IVT/EVT were older and had higher baseline pedNIHSS scores.
  • No significant differences in death or bleeding complications were observed. Median PSOM at 6 months was higher in the IVT/EVT group (2.5 vs 1, p=0.014), but only higher baseline pedNIHSS predicted unfavorable outcome.

Conclusions:

  • Recanalization treatments (IVT/EVT) appear feasible and safe in severely affected pediatric AIS patients.
  • Larger studies are required to definitively assess the efficacy of IVT/EVT in pediatric stroke.
  • Higher baseline stroke severity is a key predictor of poor outcomes in pediatric AIS.
Abstract

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