Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke: A Multi-Institutional Experience of Technical and Clinical Outcomes.
Anticoagulation
Cerebrovascular
Endovascular
Ischemic stroke
Pediatrics
Thrombectomy
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
15 12 2020
15 12 2020
Historique:
received:
17
12
2019
accepted:
19
05
2020
pubmed:
8
8
2020
medline:
17
3
2021
entrez:
8
8
2020
Statut:
ppublish
Résumé
Endovascular thrombectomy is a promising treatment for acute ischemic stroke in children, but outcome and technical data in pediatric patients with large-vessel occlusions are lacking. To assess technical and clinical outcomes of thrombectomy in pediatric patients. We undertook a retrospective cohort study of pediatric patients who experienced acute ischemic stroke from April 2017 to April 2019 who had immediate, 30-, and 90-d follow-up. Patients were treated with endovascular thrombectomy at 5 US pediatric tertiary care facilities. We recorded initial and postprocedural modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b, initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and pediatric modified Rankin scale (mRS) score 0 to 2 at 90 d. There were 23 thrombectomies in 21 patients (mean age 11.6 ± 4.9 yr, median 11.5, range 2.1-19; 52% female). A total of 19 (83%) thrombectomies resulted in mTICI grade ≥ 2b recanalization. The median PedNIHSS score was 13 on presentation (range 4-33) and 2 (range 0-26) at discharge (mean reduction 11.3 ± 6.1). A total of 14 (66%) patients had a mRS score of 0 to 2 at 30-d follow-up; 18/21 (86%) achieved that by 90 d. The median mRS was 1 (range 0-4) at 30 d and 1 (range 0-5) at 90 d. One patient required a blood transfusion after thrombectomy. In this large series of pediatric patients treated with endovascular thrombectomy, successful recanalization was accomplished via a variety of approaches with excellent clinical outcomes; further prospective longitudinal study is needed.
Sections du résumé
BACKGROUND
Endovascular thrombectomy is a promising treatment for acute ischemic stroke in children, but outcome and technical data in pediatric patients with large-vessel occlusions are lacking.
OBJECTIVE
To assess technical and clinical outcomes of thrombectomy in pediatric patients.
METHODS
We undertook a retrospective cohort study of pediatric patients who experienced acute ischemic stroke from April 2017 to April 2019 who had immediate, 30-, and 90-d follow-up. Patients were treated with endovascular thrombectomy at 5 US pediatric tertiary care facilities. We recorded initial and postprocedural modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b, initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and pediatric modified Rankin scale (mRS) score 0 to 2 at 90 d.
RESULTS
There were 23 thrombectomies in 21 patients (mean age 11.6 ± 4.9 yr, median 11.5, range 2.1-19; 52% female). A total of 19 (83%) thrombectomies resulted in mTICI grade ≥ 2b recanalization. The median PedNIHSS score was 13 on presentation (range 4-33) and 2 (range 0-26) at discharge (mean reduction 11.3 ± 6.1). A total of 14 (66%) patients had a mRS score of 0 to 2 at 30-d follow-up; 18/21 (86%) achieved that by 90 d. The median mRS was 1 (range 0-4) at 30 d and 1 (range 0-5) at 90 d. One patient required a blood transfusion after thrombectomy.
CONCLUSION
In this large series of pediatric patients treated with endovascular thrombectomy, successful recanalization was accomplished via a variety of approaches with excellent clinical outcomes; further prospective longitudinal study is needed.
Identifiants
pubmed: 32761237
pii: 5882007
doi: 10.1093/neuros/nyaa312
pmc: PMC8660626
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
46-54Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002538
Pays : United States
Informations de copyright
Copyright © 2020 by the Congress of Neurological Surgeons.
Références
Interv Neuroradiol. 2020 Apr;26(2):195-204
pubmed: 31822162
N Engl J Med. 2018 Feb 22;378(8):708-718
pubmed: 29364767
Lancet Neurol. 2009 Jun;8(6):530-6
pubmed: 19423401
Tech Vasc Interv Radiol. 2011 Mar;14(1):42-9
pubmed: 21335292
Ann Thorac Surg. 2013 Sep;96(3):e65-7
pubmed: 23992733
J Neurosurg Pediatr. 2019 Aug 9;:1-14
pubmed: 31398697
Lancet. 2000 May 13;355(9216):1670-4
pubmed: 10905241
Dev Med Child Neurol. 2008 Jul;50(7):537-40
pubmed: 18611205
N Engl J Med. 2018 Jan 4;378(1):11-21
pubmed: 29129157
JAMA Neurol. 2020 Jan 1;77(1):25-34
pubmed: 31609380
J Child Neurol. 2000 May;15(5):316-24
pubmed: 10830198
Neuroepidemiology. 2009;32(4):279-86
pubmed: 19223687
Stroke. 2011 Mar;42(3):613-7
pubmed: 21317270
J Neurointerv Surg. 2019 Sep;11(9):940-946
pubmed: 31097548
Stroke. 2008 Sep;39(9):2644-91
pubmed: 18635845
Stroke. 2006 Oct;37(10):2535-9
pubmed: 16946163
J Neurointerv Surg. 2019 Jul;11(7):729-732
pubmed: 30842301
Neurology. 2003 Jul 22;61(2):189-94
pubmed: 12874397
Stroke. 2017 Jul;48(7):2026-2030
pubmed: 28596450
Stroke. 2009 Dec;40(12):3834-40
pubmed: 19834014
N Engl J Med. 2015 Mar 12;372(11):1019-30
pubmed: 25671798
J Allied Health. 2012 Fall;41(3):e63-7
pubmed: 22968778
Int J Stroke. 2015 Apr;10(3):439-48
pubmed: 25777831
Pediatrics. 2002 Nov;110(5):924-8
pubmed: 12415031
Neurology. 2012 Sep 25;79(13 Suppl 1):S158-64
pubmed: 23008391
Pediatr Transplant. 2014 May;18(3):E88-92
pubmed: 24646292
Brain Dev. 2018 Jan;40(1):81-84
pubmed: 28844524
N Engl J Med. 2013 Jun 20;368(25):2431
pubmed: 23782185
J Stroke Cerebrovasc Dis. 2020 Feb;29(2):104551
pubmed: 31843352
Transpl Int. 2012 Mar;25(3):e31-3
pubmed: 22211986
Lancet Neurol. 2009 Dec;8(12):1120-7
pubmed: 19801204
J Neurol Neurosurg Psychiatry. 2015 Aug;86(8):917-21
pubmed: 25342203
N Engl J Med. 2015 Jun 11;372(24):2296-306
pubmed: 25882510
J Neurointerv Surg. 2017 Aug;9(8):732-737
pubmed: 27448827
Front Neurol. 2017 Nov 30;8:651
pubmed: 29250029
Stroke. 2013 Sep;44(9):2650-63
pubmed: 23920012