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Published on: April 21, 2017
Acute recanalization treatments in postnatal paediatric ischaemic arterial stroke. Paediatric stroke code
Pedro de Castro de Castro1, María Vazquez Lopez1, Antonio Gil Nuñez1
1Hospital Gregorio Marañón, Madrid, Spain.
Insights
Acute management of childhood arterial ischemic stroke is evolving with recanalization therapies like thrombolysis. These treatments show promise for pediatric stroke patients when initiated promptly within the therapeutic window.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Neonatal Medicine
Background:
- Childhood arterial ischemic stroke (AIS) is less understood than adult AIS, yet causes significant permanent disability in over 50% of cases.
- The etiology and presentation of AIS differ between pediatric and adult populations.
- High rates of severe sequelae underscore the need for effective management strategies in pediatric AIS.
Approach:
- Review of current scientific evidence on the acute management of postnatal arterial ischemic stroke (MNAIS).
- Focus on the role and efficacy of recanalization treatments, including thrombolysis and endovascular therapies.
- Assessment of treatment safety and effectiveness in children compared to adults, emphasizing eligibility criteria and therapeutic windows.
Key Points:
- Recanalization treatments are increasingly used in pediatric AIS, challenging previous non-recommendations.
- Evidence suggests these treatments are as safe and effective in children as in adults, provided strict criteria are met.
- Early initiation of treatment is crucial for favorable outcomes in MNAIS.
Conclusions:
- The acute management of MNAIS has been significantly advanced by recanalization therapies.
- Implementation of a pediatric stroke code, mirroring adult protocols, is essential for timely treatment.
- Widespread adoption of pediatric stroke codes is necessary to improve access to life-saving interventions across all regions.
Abstract:
In children, arterial ischemic stroke is a much less understood disease compared to in adults due to its lower frequency and different aetiology. However, it is also a serious disease, with a high incidence of severe and permanent sequelae that exceeds 50% of total cases. The acute management of postnatal arterial ischaemic stroke (MNAIS) has changed drastically in recent years, chiefly on account of recanalization treatments (thrombolysis and endovascular therapies). These treatments, which used to not be recommended in childhood, are increasingly implemented in everyday clinical practice. Although the evidence from studies carried out in children is not of high quality due to their retrospective design and the small number of reported cases, they support the hypothesis that these treatments are as safe and effective as they are in adults as long as appropriate eligibility criteria are applied and they are used within a certain time from the onset of symptoms (therapeutic window). This article reviews the MNAIS based on the current scientific evidence. Since the efficacy of these treatments is highly dependent on their early initiation, a paediatric stroke code needs to be in place as an extension of the stroke code applied to adults. It has started to be introduced in Spain since 2019, although there are still large areas of the country where it has yet to be applied.
