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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Treatment for Acute Ischemic Stroke in Children: Experience From the MR CLEAN Registry
Adriaan C G M van Es1, Maayke A W Hunfeld1, Ido van den Wijngaard2
1Department of Radiology and Nuclear Medicine, Leiden University Medical Center, the Netherlands (A.C.G.M.v.E.).
Insights
Endovascular therapy (EVT) shows promise for treating acute ischemic stroke in children, with many experiencing favorable outcomes. However, further research is needed to confirm its safety and efficacy in pediatric populations.
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neuroradiology
Background:
- Acute ischemic stroke in children has devastating long-term consequences.
- Limited data exists on endovascular therapy (EVT) for pediatric stroke, with only case reports available.
- Adult stroke trials demonstrate EVT's efficacy and safety.
Purpose of the Study:
- To evaluate the safety and efficacy of EVT in children with anterior circulation acute ischemic stroke.
- To analyze outcomes of pediatric patients treated within the MR CLEAN Registry.
Main Methods:
- Retrospective review of 9 children (13 months to 16 years) treated with EVT for acute ischemic stroke.
- Data collected on stroke cause, time to treatment, and complications up to 6 months post-EVT.
- Included patients with thromboembolism due to left ventricular assist device complications.
Main Results:
- EVT was technically successful in all but one patient, with no major periprocedural complications.
- Three children achieved complete recovery, and four showed partial recovery at 24 hours.
- Five of the six survivors had a favorable outcome (modified Rankin Scale score 0-2) at 6 months; mortality occurred in three patients, two with left ventricular assist devices.
Conclusions:
- EVT appears safe and feasible for pediatric acute ischemic stroke.
- Findings suggest potential benefits, but caution is advised due to small sample size.
- Larger studies are necessary to establish the risk-benefit profile of EVT in children.
Background And Purpose:
Multiple trials have shown the efficacy and safety of endovascular therapy (EVT) of acute ischemic stroke in adults. Trials in children are lacking and only case reports and case series exist. However, the long-term outcome of children with acute ischemic stroke can be devastating with significant mortality and morbidity. In this study, we describe the safety and efficacy of EVT in children with anterior circulation acute ischemic stroke who were included in the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands).
Methods:
Patients under the age of 18 years who were treated with EVT for acute ischemic stroke between March 2014 and July 2017 were retrospectively reviewed up to 6 months after EVT. Nine children, aged 13 months to 16 years (median 14 years, interquartile range, 3-15 years), underwent EVT. Stroke cause was thromboembolism in children with end-stage heart failure on left ventricular assist device (4 of these 9 cases). Median time from onset to imaging was 133 minutes. Four children received intravenous alteplase before EVT, with median onset to needle time of 165 minutes. In all but one patient, EVT was technically successful. No major periprocedural complications occurred.
Results:
At 24 hours after EVT, 3 children completely recovered and 4 children showed partial recovery (median National Institutes of Health Stroke Scale, 3.5), whereas 2 patients on left ventricular assist device died within the first week due to the occurrence of multiple strokes. One patient on left ventricular assist device developed a fatal massive intracranial hemorrhage and another child died due to left ventricular assist device-related complications. Among the 5 stroke survivors, all had a favorable outcome (modified Rankin Scale score, 0-2) at 6 months follow-up.
Conclusions:
EVT of children with acute ischemic stroke seems safe and feasible. However, these findings should be interpreted with caution as more and larger studies are needed to clarify the trade-off between risks and benefits of this treatment.
