Thrombectomy Versus Medical Management for Pediatric Arterial Ischemic Stroke With Large Baseline Infarct

Area of Science:

• Neurology
• Pediatric Stroke
• Interventional Neuroradiology

Background:

• Large vessel occlusion (LVO) stroke in adults with large infarcts benefits from thrombectomy.
• Pediatric thrombectomy shows promise, but its role in severe pediatric stroke remains unclear.

Purpose of the Study:

• To evaluate the effectiveness of thrombectomy in pediatric patients with anterior circulation LVO stroke and low Alberta Stroke Program Early CT Score (ASPECTS).

Main Methods:

• A case-control study pooled data from three pediatric stroke cohorts.
• Included were 40 pediatric patients (age 1-18) with anterior circulation LVO and ASPECTS 0-5, treated within 24 hours.
• Compared thrombectomy patients (n=24) with medically managed patients (n=16) using pediatric modified Rankin Scale (pmRS) at 90 days.

Main Results:

• Thrombectomy patients achieved significantly better pmRS scores at 90 days (OR, 3.68; P=0.034).
• No significant difference in symptomatic intracranial hemorrhage rates between groups (P=0.806).

Conclusions:

• Pediatric patients with LVO stroke and low ASPECTS benefit from thrombectomy regarding functional outcomes.
• Excluding pediatric stroke patients from thrombectomy based solely on low ASPECTS may be inappropriate.