Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke

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.