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Updated: Sep 30, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke
Alis J Dicpinigaitis1, Chirag D Gandhi2, Jared Pisapia2
1School of Medicine, New York Medical College, Valhalla (A.J.D.).
Insights
Endovascular thrombectomy (EVT) is a safe treatment for pediatric ischemic stroke, showing high rates of favorable outcomes. Further research is needed to confirm its benefits compared to medical management.
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neurology
Background:
- Limited evidence exists on endovascular thrombectomy (EVT) for pediatric ischemic stroke.
- Current practice often extrapolates adult data for EVT justification.
- Need for robust data on EVT utilization and outcomes in children.
Purpose of the Study:
- To evaluate the utilization and clinical outcomes of EVT in pediatric ischemic stroke patients.
- To compare outcomes of EVT-treated patients with those receiving medical management.
- To assess the safety and efficacy of EVT in a pediatric population.
Main Methods:
- Analysis of weighted discharge data from the National Inpatient Sample (2010-2019).
- Identification of pediatric ischemic stroke patients (<18 years).
- Application of complex samples statistical methods and propensity adjustment for outcome comparison.
Main Results:
- EVT was used in 2.6% of 7365 pediatric ischemic stroke cases, with increased utilization post-2016.
- EVT-treated patients showed high rates of favorable functional outcomes (55.3%) with no reported complications.
- Propensity-adjusted analysis revealed nonsignificant differences in favorable outcomes between EVT and medical management (55.3% vs. 52.8%).
- Patients with NIHSS >11 and those receiving preceding thrombolysis trended towards better outcomes with EVT.
Conclusions:
- Endovascular thrombectomy (EVT) appears to be a safe treatment for pediatric ischemic stroke.
- EVT is associated with high rates of favorable functional outcomes at discharge.
- Further investigation is warranted to fully elucidate EVT's comparative effectiveness in pediatric stroke.
Background:
Evidence regarding the utilization and outcomes of endovascular thrombectomy (EVT) for pediatric ischemic stroke is limited, and justification for its use is largely based on extrapolation from clinical benefits observed in adults.
Methods:
Weighted discharge data from the National Inpatient Sample were queried to identify pediatric patients with ischemic stroke (<18 years old) during the period of 2010 to 2019. Complex samples statistical methods were used to characterize the profiles and clinical outcomes of EVT-treated patients. Propensity adjustment was performed to address confounding by indication for EVT based on disparities in baseline characteristics between EVT-treated patients and those medically managed.
Results:
Among 7365 pediatric patients with ischemic stroke identified, 190 (2.6%) were treated with EVT. Utilization significantly increased in the post-EVT clinical trial era (2016-2019; 1.7% versus 4.0%; P<0.001), while the use of decompressive hemicraniectomy decreased (2.8% versus 0.7%; P<0.001). On unadjusted analysis, 105 (55.3%) EVT-treated patients achieved favorable functional outcomes at discharge (home or to acute rehabilitation), while no periprocedural iatrogenic complications or instances of contrast-induced kidney injury were reported. Following propensity adjustment, EVT-treated patients demonstrated higher absolute but nonsignificant rates of favorable functional outcomes in comparison with medically managed patients (55.3% versus 52.8%; P=0.830; adjusted hazard ratio, 1.01 [95% CI, 0.51-2.03]; P=0.972 for unfavorable outcome). Among patients with baseline National Institutes of Health Stroke Scale score >11 (75th percentile of scores in cohort), EVT-treated patients trended toward higher rates of favorable functional outcomes compared with those treated medically only (71.4% versus 55.6%; P=0.146). In a subcohort assessment of EVT-treated patients, those administered preceding thrombolytic therapy (n=79, 41.6%) trended toward higher rates of favorable functional outcomes (63.3% versus 49.5%; P=0.060).
Conclusions:
This cross-sectional evaluation of the clinical course and short-term outcomes of pediatric patients with ischemic stroke treated with EVT demonstrates that EVT is likely a safe modality which confers high rates of favorable functional outcomes.
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