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Updated: Jun 11, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular treatment in pediatric stroke: an individual patient pooled analysis on presentation, management and
Wanqiu Zhang1, Cuirong Duan2, Mingyang Niu3
1Department of Neurology, The First Affiliated Hospital of USTC, Hefei, Anhui, China.
Insights
Pediatric stroke patients with large vessel occlusion (LVO) undergoing endovascular treatment (EVT) often have good outcomes. However, higher scores on the pediatric National Institutes of Health Stroke Scale (pedNIHSS) and failed reperfusion increase the risk of poor prognosis.
Area of Science:
- Neurology
- Pediatric Stroke Research
- Interventional Neurology
Background:
- Large vessel occlusion (LVO) is a critical condition in pediatric stroke.
- Endovascular treatment (EVT) offers a therapeutic option for pediatric LVO.
- Understanding the disease landscape, management, and outcomes is crucial for improving care.
Purpose of the Study:
- To conduct a comprehensive pooled analysis of pediatric LVO patients treated with EVT.
- To investigate the presentation, management, and outcomes in this population.
- To identify risk factors associated with outcomes after EVT for pediatric stroke.
Main Methods:
- Pooled analysis of published literature (1980-2023) and registry data.
- Inclusion of pediatric LVO cases undergoing EVT.
- Analysis of risk factors for unfavorable outcomes using Cox proportional hazards models.
Main Results:
- 221 pediatric patients with LVO treated with EVT were included.
- 20.8% experienced unfavorable outcomes at 6-month follow-up.
- Higher pedNIHSS scores and unsuccessful reperfusion were linked to unfavorable outcomes; older age was protective.
Conclusions:
- A significant portion of pediatric LVO patients achieve favorable outcomes post-EVT.
- Pediatric stroke severity (pedNIHSS) and reperfusion success are key prognostic indicators.
- EVT is a viable treatment, but risk factor management is essential for better prognosis.
Background:
This study aimed to perform a comprehensive pooled analysis of all published series involving pediatric patients with large vessel occlusion (LVO) undergoing endovascular treatment (EVT) to study the disease landscape including presentation, management, and outcomes.
Methods:
The data used in this study were pooled from published literature on EVT for pediatric stroke spanning from 1980 to 2023. The relevant articles were carefully reviewed, and only those reporting at least one case of pediatric LVO undergoing EVT were included. Furthermore, pediatric patients with LVO who received EVT from the Chinese Pediatric Ischemic Stroke Registry database were also included. The primary outcome for this study was the unfavorable outcome after stroke. The risk factors influencing the outcomes of patients with pediatric stroke treated with EVT were analyzed using Cox proportional hazards models.
Results:
A total of 221 pediatric patients who underwent EVT were included. During an average follow-up period of 6 months, 20.8% of patients had an unfavorable outcome. Multivariate Cox regression showed that patients with a higher Pediatric National Institutes of Health Stroke Scale (pedNIHSS) score (aHR=7.54, 95% CI 2.38 to 23.58) and unsuccessful reperfusion (aHR=5.84, 95% CI 2.86 to 11.93) were associated with an increased risk of unfavorable outcomes, while older age (aHR=0.27, 95% CI 0.09 to 0.82) was associated with a lower risk of unfavorable outcomes.
Conclusion:
Following EVT treatment, a significant proportion of pediatric patients with LVO achieved favorable outcomes. However, factors such as the severity of the pedNIHSS score and unsuccessful reperfusion were found to be associated with a poorer prognosis.
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