Premium
Feasibility, safety, and outcome of recanalization treatment in childhood stroke
Author(s) -
Bigi Sandra,
Dulcey Andrea,
Gralla Jan,
Bernasconi Corrado,
Melliger Amber,
Datta Alexandre N.,
Arnold Marcel,
Kaesmacher Johannes,
Fluss Joel,
Hackenberg Annette,
Maier Oliver,
Weber Johannes,
Poloni Claudia,
Fischer Urs,
Steinlin Maja
Publication year - 2018
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25242
Subject(s) - medicine , stroke (engine) , outcome (game theory) , physical medicine and rehabilitation , pediatrics , physics , mathematics , mathematical economics , thermodynamics
Objective Intravenous thrombolysis and endovascular therapy (IVT/EVT) are evidence‐based treatments for adults with arterial ischemic stroke (AIS). However, randomized controlled trials in pediatric patients are lacking. This study aimed to describe feasibility, safety, and outcome of IVT/EVT in children with AIS. Methods This retrospective study (01/2000–12/2015) included a multicenter, population‐based consecutive cohort of patients aged 1 month to 16 years, diagnosed with AIS and presenting with pediatric National Institutes of Health Stroke Scale (pedNIHSS) ≥ 4. Clinical and radiological data of patients receiving IVT/EVT were compared to those receiving standard care (SC) using linear regression to adjust for potential confounders. EVT included intra‐arterial thrombolysis and/or mechanical thrombectomy. Outcome was assessed 6 months after stroke using the pediatric stroke outcome measure (PSOM). Results Overall, 150 patients (age 7.1 ± 4.9 years, 55 [37%] females) presented with pedNIHSS ≥ 4. Recanalization treatment was performed in 16 (11%), of whom 5 (3%) were treated with IVT and 11 (7%) with EVT. Patients receiving recanalization treatment were older (mean age = 11.0 vs 6.9 years, p = 0.01) and more severely affected (median pedNIHSS = 13.5 vs 8.0, p < 0.001). Death and bleeding complications did not differ between the 2 groups. Median (interquartile range) PSOM 6 months after AIS was 2.5 (1–4.3) and 1 (0–2) in the IVT/EVT and SC groups, respectively ( p = 0.014). However, after multiple linear regression analysis, only higher baseline pedNIHSS remained associated with an unfavorable outcome ( p < 0.001). Interpretation Recanalization treatment is feasible and seems to be safe in severely affected pediatric AIS patients. The assessment of efficacy of IVT/EVT in pediatric stroke patients requires larger studies. Ann Neurol 2018;83:1125–1132