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Published on: May 5, 2023
Outcome of Pediatric Large Vessel Occlusion Stroke in Denmark
Julie Brix Bindslev1,2, Klaus Hansen1,3, Nicol Dara Matoor1
1Department of Neurology University Hospital of Copenhagen, Rigshospitalet Copenhagen Denmark.
Insights
Mechanical thrombectomy (MT) is a feasible and safe treatment for pediatric large-vessel occlusion (LVO) stroke. While outcomes trended better with MT, significant differences were not observed between MT and conservative treatment in children due to small sample sizes.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Clinical Outcomes Research
Background:
- Large-vessel occlusion (LVO) stroke in children is a critical condition requiring effective treatment strategies.
- Evaluating the efficacy and safety of mechanical thrombectomy (MT) versus conservative management is essential for pediatric stroke care.
Purpose of the Study:
- To compare the clinical outcomes of pediatric patients with LVO stroke treated with MT versus conservative care.
- To assess the feasibility and safety of MT in a pediatric population.
Main Methods:
- Nationwide study utilizing data from a pediatric stroke triage-setup and the Danish National Registry of Patients (2011-2023).
- Inclusion criteria: children (29 days to 17 years) with arterial ischemic stroke and LVO.
- Outcome assessment using the modified Rankin scale.
Main Results:
- Of 181 identified pediatric arterial ischemic strokes, 28 had LVOs; 14 underwent MT and 14 received conservative treatment.
- Successful reperfusion was achieved in 92.9% of MT cases, with 2 periprocedural complications.
- Poor long-term outcome (modified Rankin scale score 3-6) was observed in 35.7% of MT patients versus 50.0% of conservatively treated patients.
Conclusions:
- Mechanical thrombectomy (MT) is feasible and appears safe for treating pediatric large-vessel occlusion (LVO) stroke.
- Outcomes tended to favor MT over conservative treatment, though statistical significance was not reached due to small sample sizes.
- Further research with larger cohorts is warranted to confirm the benefits of MT in pediatric LVO stroke.
Background:
We performed a nationwide study to examine clinical outcome in children with large-vessel occlusion (LVO) stroke treated with mechanical thrombectomy (MT) or conservatively.
Methods:
Study participants were enrolled by 2 methods: (1) registration of children assessed through a pediatric stroke triage-setup from January 2021 to June 2023 and (2) identification of children registered with a stroke or stroke-related diagnosis in the Danish National Registry of Patients between January 2011 and December 2020. Medical records were reviewed to validate possible stroke events. Children aged 29 days to 17 years with arterial ischemic stroke were included. The children were followed up for cause of stroke, site of vessel occlusion, treatment characteristics, and clinical outcome according to the modified Rankin scale.
Results:
A total of 181 children with arterial ischemic stroke were identified. Angiography descriptions were available in 133 children and demonstrated LVOs in 28 (21.1%) of these. Fourteen children with LVOs underwent MT and 14 were treated conservatively. Thirteen of 14 (92.9%) children treated with MT achieved successful reperfusion. Periprocedural complications were observed in 2 children, including 1 child who developed symptomatic intracerebral hemorrhage <24 hours from MT. Long-term outcome was poor (modified Rankin scale score 3-6) in 7 out of 14 (50.0%) children with LVOs treated conservatively and 5 out of 14 (35.7%) children treated with MT. When limiting analysis to MT procedures performed within 24 hours from stroke onset, a poor outcome was observed in 3 out of 11 (27.3%) children treated with MT. Outcome did not differ significantly between treatment groups.
Conclusion:
This nationwide study demonstrates that MT is feasible and apparently safe to use in children. Among children with LVOs, outcome tended to be better for those treated with MT than those treated conservatively, but outcome did not differ significantly between groups, likely due to small sample sizes.
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