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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Trends in endovascular interventions for pediatric ischemic stroke at the national level: data from 2000 to 2009
Faris Shweikeh1, Miriam Nuno2, Matthew Adamo3
1Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. faris.shweikeh@gmail.com.
Insights
Neurointerventions for pediatric acute ischemic stroke (AIS) are increasingly used, with endovascular procedures showing lower mortality than thrombolysis. This study analyzed national data on neurointervention practices in children with AIS.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Knowledge gaps exist regarding endovascular and interventional management of pediatric acute ischemic stroke (AIS).
- Current neurointervention practices in pediatric AIS require analysis using national data.
Purpose of the Study:
- To analyze the current practice of neurointerventions in pediatric patients diagnosed with acute ischemic stroke (AIS).
- To evaluate outcomes, comorbidities, and costs associated with different neurointervention strategies in children.
Main Methods:
- Utilized the Kids' Inpatient Database (2000, 2003, 2006, 2009) for patients under 18 with primary AIS diagnosis.
- Identified and analyzed patient cohorts undergoing angiograms, thrombolysis, and endovascular recanalization.
- Performed descriptive statistical analysis on subcohorts to compare demographics, outcomes, and charges.
Main Results:
- 3467 pediatric AIS patients identified; 26.5% had angiograms, 1.5% angiogram + thrombolysis, 0.5% endovascular recanalization.
- Endovascular procedures were associated with younger patient age (mean 14.9 years) compared to thrombolysis (12.2 years).
- Mortality was significantly lower with endovascular procedures (4.3%) versus thrombolysis (18.2%), with higher charges for thrombolysis.
Conclusions:
- Children undergoing neurointerventions for AIS are typically older (>12 years) with cardiac comorbidities.
- Endovascular procedures demonstrated lower mortality and fewer complications compared to thrombolysis alone.
- Thrombolysis was linked to more non-routine discharges and longer hospital stays.
Purpose:
Present knowledge is limited with regard to endovascular and interventional management of pediatric acute ischemic stroke (AIS). The current practice of neurointerventions in this population was analyzed via a national database.
Methods:
The Kids' Inpatient Database for years 2000, 2003, 2006, and 2009 was examined for patients aged < 18 years discharged with a primary diagnosis of AIS and identified according to ICD-9 codes. Descriptive statistics were tabulated on each of the subcohorts.
Results:
There were 3467 patients identified; 920 (26.5%) underwent angiograms, 51 (1.5%) angiogram + thrombolysis, and 18 (0.5%) received angiogram + endovascular recanalization. The angiogram only subcohort was significantly younger compared with thrombolysis and endovascular procedure subcohorts (9.8 vs. 12.2 vs. 14.9 years, P < 0.001). Mortality was 4.3%, significantly lower for angiogram only than for thrombolysis (1.1% vs. 18.2%, P < 0.0001). Thrombolysis also had significantly higher hospital charges ($149,045 vs. $64,826, P < 0.0001). While not many differences in outcomes between angiogram only versus endovascular procedures, the latter had higher financial burden ($122,482 vs. $64,826, P < 0.0001).
Conclusions:
This national study suggests that children receiving neurointerventions tend to be older (> 12 years) and heart and valvular defects are their most likely comorbidities. There was a lower mortality and fewer complications with endovascular procedures when compared with intravenous/intraarterial thrombolysis alone. Thrombolysis was also associated with more non-routine discharges and lengthier stay.
