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Safety and efficacy of recanalization therapy in pediatric stroke: A systematic review and meta-analysis

Juliana T Pacheco1, Timo Siepmann2, Jessica Barlinn3

  • 1Division of Health Care Sciences, Dresden International University, Dresden, Germany.

European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society
|August 21, 2018
PubMed

Insights

Evidence on acute recanalization therapies for pediatric acute ischemic stroke (AIS) is limited. Intravenous thrombolysis in children showed increased risk of intracranial hemorrhage but similar in-hospital mortality, with no data on efficacy.

Area of Science:

  • Pediatric Neurology
  • Neurocritical Care
  • Stroke Medicine

Background:

  • Acute ischemic stroke (AIS) in children is a significant concern.
  • The safety and efficacy of acute recanalization therapies, including intravenous thrombolysis and endovascular therapy, in pediatric AIS are not well-established.
  • Current evidence for these treatments in children is scarce.

Purpose of the Study:

  • To systematically review and synthesize available evidence on the safety and efficacy of acute recanalization therapies in pediatric AIS patients.
  • To evaluate outcomes of intravenous thrombolysis and endovascular therapy in children under 18 years old.
  • To identify gaps in current research regarding these treatments.

Main Methods:

  • A systematic review and meta-analysis of studies on pediatric AIS patients (<18 years) treated with thrombolysis or endovascular therapy.
  • Searched Medline and Cochrane Library databases for eligible studies published up to August 31, 2016.
  • Assessed safety outcomes (intracranial hemorrhage, mortality) and efficacy outcomes (functional status at 3-6 months).

Main Results:

  • Only 3 studies with 16,987 pediatric patients met eligibility criteria; 181 received IV thrombolysis.
  • No randomized trials or data on endovascular thrombectomy were found.
  • IV thrombolysis was associated with an increased risk of any intracranial hemorrhage (RR=3.48) but similar in-hospital mortality compared to controls.
  • Complete data on symptomatic intracranial hemorrhage and efficacy outcomes were lacking.

Conclusions:

  • There is a substantial lack of high-quality data regarding the safety and efficacy of acute recanalization therapies for pediatric AIS.
  • Further research, including randomized controlled trials, is urgently needed to establish optimal treatment strategies for children with AIS.
  • Current evidence suggests potential risks associated with IV thrombolysis in children, necessitating cautious application.
Abstract

Keywords:
Endovascular therapyIntraarterial thrombolysisIntravenous thrombolysisMechanical thrombectomyPediatric stroke

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