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Recanalization strategies in childhood stroke in Germany
Martin Olivieri1, Anna-Lisa Sorg2, Raphael Weinberger2
1Pediatric Hemostasis and Thrombosis Unit, Department of Pediatrics, Dr Von Hauner Children's Hospital, University Hospital, LMU Munich, Lindwurmstr. 4, 80337, Munich, Germany. martin.olivieri@med.uni-muenchen.de.
Insights
Recanalization therapy is a feasible and increasingly used treatment for childhood arterial ischemic stroke (CAIS). Timely diagnosis and expert care can improve treatment times for pediatric stroke patients.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Rare Diseases
Background:
- Childhood arterial ischemic stroke (CAIS) is rare, with varied causes and symptoms complicating diagnosis.
- Delayed diagnosis hinders prompt recanalization strategies in pediatric stroke.
Purpose of the Study:
- To analyze recanalization therapy outcomes in a subgroup of pediatric AIS patients.
- To compare characteristics and treatment times between patients receiving recanalization therapy and the overall AIS cohort.
Main Methods:
- Retrospective analysis of 164 pediatric first-time AIS cases (age >28 days to 18 years) from 2015-2017.
- Subgroup analysis focused on 28 patients (17%) who received recanalization therapy.
- Comparison of diagnostic and treatment times between the intervention and overall groups.
Main Results:
- Patients receiving recanalization therapy had a significantly shorter time from symptom onset to diagnosis (4.1h vs. 20.4h).
- Hemiparesis, facial weakness, and speech disturbance were common symptoms in the recanalization group.
- Cardiac disease was a more frequent risk factor in the recanalization group; only one minor bleed occurred.
Conclusions:
- Recanalization therapies are feasible and increasingly utilized in pediatric AIS.
- High awareness, rapid diagnosis, and specialized expertise are crucial for improving hyperacute treatment in children.
- Optimizing these factors can expand the availability of time-sensitive therapies for pediatric stroke.
Abstract:
Childhood arterial ischemic stroke (CAIS) is a rare event. Diverse etiologies, risk factors, symptoms and stroke mimics hamper obtaining a fast diagnosis and implementing immediate recanalization strategies. Over a period of 3 years (2015-2017), the data of 164 pediatric patients (> 28 days of life-18 years) with a first episode of AIS were submitted to a hospital-based nationwide surveillance system for rare disorders (ESPED). We report a subgroup analysis of patients who have undergone recanalization therapy and compare these data with those of the whole group. Twenty-eight patients (17%) with a median age of 12.2 years (range 3.3-16.9) received recanalization therapy. Hemiparesis, facial weakness and speech disturbance were the main presenting symptoms. The time from onset of symptoms to confirmation of diagnosis was significantly shorter in the intervention group (4.1 h vs. 20.4 h, p ≤ 0.0001). Only in one patient occurred a minor bleed. Cardiac disease as predisposing risk factor was more common in the recanalization group. Recanalization therapies are feasible and increasingly applied in children with AIS. High awareness, timely diagnosis and a large amount of expertise may improve time to treatment and make hyperacute therapy an option for more patients.
