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The Stroke Preclinical Assessment Network Multi-Laboratory Model of Thromboembolic Stroke with Thrombolysis: TE-MCAo
Published on: December 19, 2025
Mechanical thrombectomy for pediatric large-vessel occlusion: a systematic review and meta-analysis with post hoc
Fandi Hendrawan1, Janice Geraldine Chen2, Graciela Natalia Chandra3
1Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Senolowo, Jl. Farmako, Sekip Utara, Kec. Depok, Special Region of Yogyakarta, 55281, Indonesia. hendrawanfandi4@gmail.com.
Insights
Mechanical thrombectomy (MT) may benefit pediatric large vessel occlusion (LVO) stroke patients, but current evidence is limited. More research is needed to confirm MT
Area of Science:
- Neurology
- Pediatric Stroke
- Interventional Neurology
Background:
- Pediatric large vessel occlusion (LVO) is a rare but severe form of ischemic stroke.
- Mechanical thrombectomy (MT) is standard for adult LVO, but its role in children is less understood.
- Existing studies on MT for pediatric LVO are observational and yield conflicting results.
Purpose of the Study:
- To evaluate the efficacy and safety of mechanical thrombectomy (MT) for pediatric large vessel occlusion (LVO).
- To compare MT outcomes against medical management, including intravenous thrombolysis (IVT) and conservative treatment.
Main Methods:
- A systematic review adhering to PRISMA 2020 guidelines.
- Inclusion of studies comparing MT with medical management in pediatric LVO patients.
- Primary endpoint: favorable outcome; secondary endpoint: mortality rate.
- Exploratory analyses included Bayesian inference and trial sequential analysis (TSA).
Main Results:
- Six studies with 230 MT-treated and 206 non-MT patients were analyzed.
- No significant difference in favorable outcomes between MT and medical management in primary analysis (OR 1.83).
- Bayesian analysis supported a potential benefit of MT (OR 1.75).
- Subgroup analyses favored MT over IVT and conservative treatment, but Bayesian models did not support these.
- Insufficient evidence for mortality differences; TSA indicated inadequate sample size for definitive conclusions.
Conclusions:
- Observational data suggest MT may be associated with favorable outcomes in pediatric LVO.
- Current findings are hypothesis-generating, requiring cautious interpretation.
- Adequately powered prospective studies are essential before recommending MT for pediatric LVO.
Objective:
To investigate the outcome of pediatric large vessel occlusion (LVO) treated with mechanical thrombectomy (MT).
Introduction:
Pediatric LVO is a rare subtype of ischemic stroke. In adults, MT is recommended; however, the efficacy and safety of MT in pediatric LVO are less explored. The available studies are mostly observational studies; yet, these studies show inconsistent findings.
Method:
This review adhered to the PRISMA 2020 guideline. Studies comparing MT with medical management in pediatric with LVO were included. The primary endpoint was the favourable outcome. The mortality rate was sought as well. Subgroup analysis compared MT with intravenous thrombolysis (IVT) and conservative management. Post hoc exploratory analyses comprised Bayesian inference and trial sequential analysis (TSA).
Result:
Six studies comprising a total of 230 MT-treated and 206 non-MT patients were included. In the primary analysis, favourable outcome did not differ significantly between the MT and medical management groups (OR 1.83; 95% CI 0.97-3.43), while supported by exploratory Bayesian inference (OR 1.75; 95% CrI 1.05-2.67; BF10 5.05). Subgroup analysis showed favourable outcomes of MT over IVT (OR 2.39; 95% CI 1.19-4.79) and conservative treatment (OR 2.22; 95% CI 1.41-3.51), although the Bayesian model did not support these findings. The available evidence was insufficient to detect or exclude a difference in mortality between MT and medical management (OR 1.32; 95% CI 0.45-3.89). TSA indicated that the required information size was not reached and that additional trials are needed to reach the minimum sample requirements.
Conclusion:
In this synthesis of observational data, the MT may be associated with favourable outcome in pediatric LVO, however, these findings are hypothesis-generating only. Adequately powered prospective studies are needed before MT can be recommended for pediatric LVO.
Clinical Trial Number:
not applicable.
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