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Safety of mechanical thrombectomy in pediatric acute ischemic stroke: a systematic review and meta-analysis
Lucca Tamara Alves Carretta1, Ocilio Ribeiro Gonçalves2, Lucas Copolillo Faria3
1Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, Brazil. luccatamara12@gmail.com.
Insights
Mechanical thrombectomy (MT) is a safe and effective treatment for pediatric acute ischemic stroke (AIS), showing high rates of favorable outcomes and low mortality. Further research is needed to optimize patient selection and treatment protocols.
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neuroradiology
Background:
- Acute ischemic stroke (AIS) in children is a rare but serious condition.
- Mechanical thrombectomy (MT) is an emerging treatment for pediatric AIS.
- Limited data exists on the pooled outcomes and safety of MT in pediatric populations.
Purpose of the Study:
- To evaluate the clinical outcomes and safety of mechanical thrombectomy (MT) in pediatric patients with acute ischemic stroke (AIS).
- To synthesize existing evidence on MT effectiveness in children.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane Library for studies involving MT in pediatric AIS (patients ≤ 18 years).
- Data extraction included baseline characteristics, procedural details, and clinical outcomes such as functional outcome (modified Rankin Scale [mRS] 0-2), NIHSS reduction, symptomatic intracranial hemorrhage (sICH), and mortality.
- A single-arm meta-analysis was performed to estimate pooled rates of these outcomes.
Main Results:
- The meta-analysis included 25 studies with 885 pediatric patients.
- Pooled favorable functional outcome (mRS 0-2) was 80%, with a pooled mortality of 4% and symptomatic intracranial hemorrhage (sICH) of 2%.
- Successful recanalization rates were high at 88%, with low rates of no reperfusion (3%) and re-occlusion (3%).
Conclusions:
- Mechanical thrombectomy (MT) demonstrates promising safety and efficacy in pediatric acute ischemic stroke (AIS), achieving high rates of favorable functional outcomes.
- Low rates of mortality and symptomatic intracranial hemorrhage (sICH) were observed.
- Significant heterogeneity across studies necessitates further high-quality, standardized research to optimize patient selection and treatment protocols for pediatric AIS.
Purpose:
This meta-analysis aimed to evaluate the clinical outcomes and safety of mechanical thrombectomy (MT) in pediatric acute ischemic stroke (AIS).
Methods:
Systematic search of PubMed, Embase and Cochrane Library identified studies on MT in children (≤ 18 years) with AIS. Data on baseline characteristics, procedural details and clinical outcomes, including favorable functional outcome (modified Rankin Scale [mRS] 0-2), National Institutes of Health Stroke Scale (NIHSS) reduction, Pediatric Stroke Outcome Measure (PSOM), symptomatic intracranial hemorrhage (sICH) and mortality were extracted. A single-arm meta-analysis was performed to estimate pooled rates.
Results:
25 studies, encompassing 885 patients (mean age of included cohorts: 10.2-18 years), were included. The pooled favorable functional outcome was 80% (95% CI, 70%-88%), while the poor functional outcome was 14% (95% CI: 5%-26%). Mean NIHSS reduction was 8.07 (95% CI, 5.93-10.22), PedNIHSS decrease was 14.64 (95% CI: 12.04 to 17.24), and pooled mean PSOM score at follow-up was 1.02 (95% CI, 0.48-1.55). sICH was 2% (95% CI, 0-5%), need for decompressive hemicraniectomy was 7% (95% CI: 2%-14%) and overall mortality was 4% (95% CI, 1%-8%). Successful recanalization was 88% (95% CI: 81%-95%) and no reperfusion and re-occlusion were both 3% (95% CI: 0%-7%).
Conclusion:
MT appears to be a promising and safe treatment option for pediatric AIS, demonstrating high rates of favorable functional outcomes and low mortality/sICH. However, significant heterogeneity among studies highlights the need for further high-quality, standardized research to optimize patient selection and define its effectiveness.
