Relationship Between Baseline Infarct and Clinical Outcome in Pediatric Large-Vessel Occlusion Ischemic Stroke

Area of Science:

• Neurology
• Pediatric Stroke
• Medical Imaging

Background:

• The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is crucial for predicting outcomes in adult large-vessel occlusion stroke (LVOS) and guiding mechanical thrombectomy decisions.
• However, the prognostic value of ASPECTS in pediatric LVOS remains largely uncharacterized.

Purpose of the Study:

• To investigate the relationship between baseline infarct extent, measured by ASPECTS, and clinical outcomes in pediatric patients with large-vessel occlusion stroke.
• To determine if ASPECTS should influence treatment decisions for mechanical thrombectomy in children.

Main Methods:

• A secondary analysis of a retrospective multicenter case-control study involving pediatric LVOS patients from Australia and Canada (2011-2022).
• ASPECTS was assessed on baseline CT or MRI-DWI by blinded reviewers. Clinical outcomes were evaluated using pediatric modified Rankin Scale (pmRS) scores at 3 months.
• Ordinal logistic regression was used to analyze the association between ASPECTS and pmRS.

Main Results:

• The study included 24 thrombectomy and 24 control patients. Mean ASPECTS was comparable between groups (6.3 vs. 6.1).
• In the thrombectomy group, baseline ASPECTS significantly correlated with 3-month pmRS (OR, 1.58; P=0.013).
• Notably, 6 of 7 thrombectomy patients with ASPECTS <6 achieved favorable outcomes (pmRS 0-2).

Conclusions:

• Baseline ASPECTS is significantly associated with clinical outcomes in pediatric LVOS patients treated with mechanical thrombectomy.
• Favorable outcomes were observed in thrombectomy patients with lower ASPECTS scores, challenging the use of ASPECTS as an exclusion criterion.
• These findings suggest that pediatric patients with large infarcts (low ASPECTS) may still benefit from mechanical thrombectomy.