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Updated: Jul 16, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
How do children fare compared with adults? Comparing relative outcomes after thrombectomy for acute ischemic stroke
Matthew C Findlay1, Ramesh Grandhi2, Jayson R Nelson1
1School of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
Insights
Endovascular thrombectomy is a safe and effective treatment for pediatric acute ischemic stroke caused by large-vessel occlusion. This procedure shows high revascularization rates and favorable neurological outcomes in children, with fewer complications than in adults.
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neuroradiology
Background:
- Limited data exists on endovascular thrombectomy (EVT) for pediatric acute ischemic stroke (AIS) secondary to large-vessel occlusion (LVO).
- Comparison with adult outcomes is crucial for establishing pediatric treatment guidelines.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of EVT in children with AIS due to LVO.
- To compare the safety and efficacy outcomes of EVT in children versus adults.
Main Methods:
- Systematic search of PubMed, Medline, and EMBASE databases for pediatric studies (patients <18 years) on EVT for AIS-LVO.
- Meta-analysis of data from 8 pediatric studies (n=192) and comparison with 5 adult clinical trials (n=634).
Main Results:
- High recanalization rates (88.5%) and significant reduction in NIH Stroke Scale scores in children.
- Pediatric patients demonstrated superior outcomes: higher rates of good neurological outcome (76.1%) and revascularization (88.5%).
- Children experienced significantly fewer major periprocedural complications (3.6%) and lower mortality (1.0%) compared to adults (30.4% and 12.9%, respectively).
Conclusions:
- Endovascular thrombectomy is a safe and effective treatment for pediatric AIS due to LVO.
- Aggregated data shows high revascularization rates, favorable long-term neurological outcomes, and low complication rates in children.
- EVT offers a promising therapeutic option for children with AIS-LVO, with outcomes potentially superior to those observed in adult populations.
Objective:
Safety and efficacy data for endovascular thrombectomy for acute ischemic stroke secondary to large-vessel occlusion in children are lacking compared with those for adults. We undertook an updated systematic review and meta-analysis of endovascular thrombectomy in children and compared their outcomes with adult data.
Methods:
We searched PubMed, Medline, and EMBASE databases to identify prospective and retrospective studies describing patients <18 years treated with endovascular thrombectomy for acute ischemic stroke due to large-vessel occlusion.
Results:
Eight pediatric studies were included (n = 192). Most patients were male (53.1 %), experienced anterior circulation large-vessel occlusion (81.8 %), and underwent endovascular thrombectomy by stent retreiver (70.7 %). The primary outcome was change in National Institutes of Health Stroke Scale score from presentation to 24 h after thrombectomy. Secondary outcomes included modified Rankin scale score improvement and 90-day score, recanalization rates, procedural complications, and mortality rates. After treatment, 88.5% of children had successful recanalization; the mean National Institutes of Health Stroke Scale score reduction was 7.37 (95 % CI 5.11-9.63, p < 0.01). The mean reduction of 6.87 (95 %CI 5.00-8.73, p < 0.01) for adults in 5 clinical trials (n = 634) was similar (Qb = 0.11; p = 0.74). Children experienced higher rates of good neurological outcome (76.1 % vs. 46.0 %, p < 0.01) and revascularization (88.5 % vs. 72.3 %, p < 0.01), fewer major periprocedural complications (3.6 % vs. 30.4 %, p < 0.01), and lower mortality (1.0 % vs. 12.9 %, p < 0.01).
Conclusions:
Endovascular thrombectomy may be safe and effective treatment for acute ischemic stroke due to large-vessel occlusion in children. The aggregated data demonstrated high rates of revascularization, favorable long-term neurological outcomes, and low complication rates.
