Mechanical Thrombectomy for Pediatric Large Vessel Occlusions : A Systematic Review and Meta-analysis.
Adolescent
Children
Endovascular
Ischemic
Stroke
Journal
Clinical neuroradiology
ISSN: 1869-1447
Titre abrégé: Clin Neuroradiol
Pays: Germany
ID NLM: 101526693
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
14
10
2022
accepted:
22
11
2022
medline:
28
8
2023
pubmed:
3
1
2023
entrez:
2
1
2023
Statut:
ppublish
Résumé
Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke. To investigate the efficacy and safety of MT in pediatric LVO. A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). A fixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI). In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77-95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09-61.62%) of the cases. The favorable (mRS = 0-2) and excellent (mRS = 0-1) outcome rates were 83.3% (95% CI = 73.54-94.50%) and 59.5% (95% CI = 44.24-80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0-3.30%) and mortality rate was 3.2% (95% CI = 0.55-7.38%). In our meta-analysis, MT demonstrated a promising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as a first-line treatment strategy.
Sections du résumé
BACKGROUND
BACKGROUND
Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke.
PURPOSE
OBJECTIVE
To investigate the efficacy and safety of MT in pediatric LVO.
METHODS
METHODS
A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). A fixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI).
RESULTS
RESULTS
In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77-95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09-61.62%) of the cases. The favorable (mRS = 0-2) and excellent (mRS = 0-1) outcome rates were 83.3% (95% CI = 73.54-94.50%) and 59.5% (95% CI = 44.24-80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0-3.30%) and mortality rate was 3.2% (95% CI = 0.55-7.38%).
CONCLUSION
CONCLUSIONS
In our meta-analysis, MT demonstrated a promising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as a first-line treatment strategy.
Identifiants
pubmed: 36592199
doi: 10.1007/s00062-022-01246-y
pii: 10.1007/s00062-022-01246-y
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
635-644Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, Parker AP, Wassmer E, Wraige E, Amin S, Edwards HB, Tilling K, O’Callaghan FJ. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014;13:35–43. https://doi.org/10.1016/s1474-4422(13)70290-4 .
doi: 10.1016/s1474-4422(13)70290-4
pubmed: 24304598
Sporns PB, Fullerton HJ, Lee S, Kirton A, Wildgruber M. Current treatment for childhood arterial ischaemic stroke. Lancet Child Adolesc Health. 2021;5:825–36. https://doi.org/10.1016/s2352-4642(21)00167-x .
doi: 10.1016/s2352-4642(21)00167-x
pubmed: 34331864
de Veber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol. 2000;15:316–24. https://doi.org/10.1177/088307380001500508 .
doi: 10.1177/088307380001500508
Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20. https://doi.org/10.1056/NEJMoa1411587 .
doi: 10.1056/NEJMoa1411587
pubmed: 25517348
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30. https://doi.org/10.1056/NEJMoa1414905 .
doi: 10.1056/NEJMoa1414905
pubmed: 25671798
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–306. https://doi.org/10.1056/NEJMoa1503780 .
doi: 10.1056/NEJMoa1503780
pubmed: 25882510
Wintermark M, Hills NK, deVeber GA, Barkovich AJ, Elkind MS, Sear K, Zhu G, Leiva-Salinas C, Hou Q, Dowling MM, Bernard TJ, Friedman NR, Ichord RN, Fullerton HJ. Arteriopathy diagnosis in childhood arterial ischemic stroke: results of the vascular effects of infection in pediatric stroke study. Stroke. 2014;45:3597–605. https://doi.org/10.1161/strokeaha.114.007404 .
doi: 10.1161/strokeaha.114.007404
pubmed: 25388419
pmcid: 4260818
Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers. 2022;8:12. https://doi.org/10.1038/s41572-022-00337-x .
doi: 10.1038/s41572-022-00337-x
pubmed: 35210461
He L, Ladner TR, Pruthi S, Day MA, Desai AA, Jordan LC, Froehler MT. Rule of 5: angiographic diameters of cervicocerebral arteries in children and compatibility with adult neurointerventional devices. J Neurointerv Surg. 2016;8:1067–71. https://doi.org/10.1136/neurintsurg-2015-012034 .
doi: 10.1136/neurintsurg-2015-012034
pubmed: 26546602
Sun LR, Harrar D, Drocton G, Castillo-Pinto C, Gailloud P, Pearl MS. Endovascular therapy for acute stroke in children: age and size technical limitations. J Neurointerv Surg. 2021;13:794–8. https://doi.org/10.1136/neurintsurg-2021-017311 .
doi: 10.1136/neurintsurg-2021-017311
pubmed: 33832970
Heit JJ, Muthusami P, Chandra RV, Hui F, Negrotto M, Lee S, Wasserman BA, Abruzzo TA. Reperfusion therapies for children with arterial Ischemic stroke. Top Magn Reson Imaging. 2021;30:231–43. https://doi.org/10.1097/rmr.0000000000000273 . PubMed PMID: 34613946.
doi: 10.1097/rmr.0000000000000273
pubmed: 34613946
Lehman LL, Beslow LA, Steinlin M, Kossorotoff M, Mackay MT. What will improve pediatric acute stroke care? Stroke. 2019;50:249–56. https://doi.org/10.1161/strokeaha.118.022881 .
doi: 10.1161/strokeaha.118.022881
pubmed: 30661501
Beslow LA, Lo WD. Key metrics are required to refine guidelines for pediatric mechanical thrombectomy. Stroke. 2021;52:1222–4. https://doi.org/10.1161/strokeaha.120.033561 .
doi: 10.1161/strokeaha.120.033561
pubmed: 33719514
Barry M, Barry D, Kansagra AP, Hallam D, Abraham M, Amlie-Lefond C. Higher-quality data collection is critical to establish the safety and efficacy of pediatric mechanical thrombectomy. Stroke. 2021;52:1213–21. https://doi.org/10.1161/strokeaha.120.032009 .
doi: 10.1161/strokeaha.120.032009
pubmed: 33719517
Lee S, Felling RJ. Moving toward a new horizon of pediatric stroke intervention. Stroke. 2021;52:789–91. https://doi.org/10.1161/strokeaha.120.033496 .
doi: 10.1161/strokeaha.120.033496
pubmed: 33617342
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89. https://doi.org/10.1186/s13643-021-01626-4 .
doi: 10.1186/s13643-021-01626-4
pubmed: 33781348
pmcid: 8008539
Fragata I, Morais T, Silva R, Nunes AP, Loureiro P, Martins DJ, Pamplona J, Carvalho R, Baptista M, Reis J. Endovascular treatment of pediatric ischemic stroke: A single center experience and review of the literature. Interv Neuroradiol. 2021;27:16–24. https://doi.org/10.1177/1591019920958827 .
doi: 10.1177/1591019920958827
pubmed: 32903115
Bhatti A, Huded V, Vyas D, Mushtaq M, Kekatpure M, Hiremath S, Sapare A, Aggarwal R. Mechanical thrombectomy using retrievable Stents in pediatric acute Ischemic stroke. Indian Pediatr. 2019;56:571–5.
doi: 10.1007/s13312-019-1557-8
pubmed: 31333212
Shoirah H, Shallwani H, Siddiqui AH, Levy EI, Kenmuir CL, Jovin TG, Levitt MR, Kim LJ, Griauzde J, Pandey AS, Gemmete JJ, Abruzzo T, Arthur AS, Elijovich L, Hoit D, Cheema A, Aghaebrahim A, Sauvageau E, Hanel R, Ringer AJ, Nascimento FA, Kan P, Mocco J. Endovascular thrombectomy in pediatric patients with large vessel occlusion. J Neurointerv Surg. 2019;11:729–32. https://doi.org/10.1136/neurintsurg-2018-014320 .
doi: 10.1136/neurintsurg-2018-014320
pubmed: 30842301
Bigi S, Dulcey A, Gralla J, Bernasconi C, Melliger A, Datta AN, Arnold M, Kaesmacher J, Fluss J, Hackenberg A, Maier O, Weber J, Poloni C, Fischer U, Steinlin M. Feasibility, safety, and outcome of recanalization treatment in childhood stroke. Ann Neurol. 2018;83:1125–32. https://doi.org/10.1002/ana.25242 .
doi: 10.1002/ana.25242
pubmed: 29679441
Bhatia KD, Briest R, Goetti R, Webster R, Troedson C, Dale RC, Muthusami P, Miteff C, Miteff F, Worthington J, Tastula K, Ang T, Andrews I. Incidence and natural history of pediatric large vessel occlusion stroke: a population study. JAMA Neurol. 2022;79:488–97. https://doi.org/10.1001/jamaneurol.2022.0323 .
doi: 10.1001/jamaneurol.2022.0323
pubmed: 35344005
pmcid: 8961400
Ravindra VM, Alexander M, Taussky P, Bollo RJ, Hassan AE, Scoville JP, Griauzde J, Awad AW, Jumaa M, Zaidi S, Lee JJ, Hafeez MU, Nascimento FA, LoPresti MA, Couldwell WT, Hetts SW, Lam SK, Kan P, Grandhi R. Endovascular thrombectomy for pediatric acute Ischemic stroke: a multi-institutional experience of technical and clinical outcomes. Neurosurgery. 2020;88:46–54. https://doi.org/10.1093/neuros/nyaa312 .
doi: 10.1093/neuros/nyaa312
pubmed: 32761237
pmcid: 8660626
Bhogal P, Hellstern V, AlMatter M, Ganslandt O, Bäzner H, Aguilar PM, Henkes H. Mechanical thrombectomy in children and adolescents: report of five cases and literature review. Stroke Vasc Neurol. 2018;3:245–52. https://doi.org/10.1136/svn-2018-000181 .
doi: 10.1136/svn-2018-000181
pubmed: 30637131
pmcid: 6312071
van Es A, Hunfeld MAW, van den Wijngaard I, Kraemer U, Engelen M, van Hasselt B, Fransen PSS, Dippel DWJ, Majoie C, van der Lugt A, Emmer BJ. Endovascular treatment for acute ischemic stroke in children: experience from the MR CLEAN registry. Stroke. 2021;52:781–8. https://doi.org/10.1161/strokeaha.120.030210 .
doi: 10.1161/strokeaha.120.030210
pubmed: 33617341
Zhou B, Wang XC, Xiang JY, Zhang MZ, Li B, Jiang HB, Lu XD. Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke. J Neurosurg Pediatr. 2019;23:363–8. https://doi.org/10.3171/2018.9.Peds18242 .
doi: 10.3171/2018.9.Peds18242
pubmed: 30611154
Sporns PB, Sträter R, Minnerup J, Wiendl H, Hanning U, Chapot R, Henkes H, Henkes E, Grams A, Dorn F, Nikoubashman O, Wiesmann M, Bier G, Weber A, Broocks G, Fiehler J, Brehm A, Psychogios M, Kaiser D, Yilmaz U, Morotti A, Marik W, Nolz R, Jensen-Kondering U, Schmitz B, Schob S, Beuing O, Götz F, Trenkler J, Turowski B, Möhlenbruch M, Wendl C, Schramm P, Musolino P, Lee S, Schlamann M, Radbruch A, Rübsamen N, Karch A, Heindel W, Wildgruber M, Kemmling A. Feasibility, safety, and outcome of endovascular recanalization in childhood stroke: the save childS study. JAMA Neurol. 2020;77:25–34. https://doi.org/10.1001/jamaneurol.2019.3403 .
doi: 10.1001/jamaneurol.2019.3403
pubmed: 31609380
Kossorotoff M, Kerleroux B, Boulouis G, Husson B, Dong TK, Eugene F, Damaj L, Ozanne A, Bellesme C, Rolland A, Bourcier R, Triquenot-Bagan A, Marnat G, Neau JP, Joriot S, Perez A, Guillen M, Perivier M, Audic F, Hak JF, Denier C, Naggara O. Recanalization treatments for pediatric acute Ischemic stroke in France. JAMA Netw Open. 2022;5:e2231343. https://doi.org/10.1001/jamanetworkopen.2022.31343 .
doi: 10.1001/jamanetworkopen.2022.31343
pubmed: 36107427
pmcid: 9478769
Dicpinigaitis AJ, Gandhi CD, Pisapia J, Muh CR, Cooper JB, Tobias M, Mohan A, Nuoman R, Overby P, Santarelli J, Hanft S, Bowers C, Yaghi S, Mayer SA, Al-Mufti F. Endovascular thrombectomy for pediatric acute ischemic stroke. Stroke. 2022;53:1530–9. https://doi.org/10.1161/strokeaha.121.036361 .
doi: 10.1161/strokeaha.121.036361
pubmed: 35272483
Pienaar R, Paldino MJ, Madan N, Krishnamoorthy KS, Alsop DC, Dehaes M, Grant PE. A quantitative method for correlating observations of decreased apparent diffusion coefficient with elevated cerebral blood perfusion in newborns presenting cerebral ischemic insults. Neuroimage. 2012;63:1510–8. https://doi.org/10.1016/j.neuroimage.2012.07.062 .
doi: 10.1016/j.neuroimage.2012.07.062
pubmed: 22892333
Chen J, Licht DJ, Smith SE, Agner SC, Mason S, Wang S, Silvestre DW, Detre JA, Zimmerman RA, Ichord RN, Wang J. Arterial spin labeling perfusion MRI in pediatric arterial ischemic stroke: initial experiences. J Magn Reson Imaging. 2009;29:282–90. https://doi.org/10.1002/jmri.21641 .
doi: 10.1002/jmri.21641
pubmed: 19161176
pmcid: 2728589
Wright JN. Spontaneous recanalization and hyperperfusion are relatively common at presentation in pediatric arterial ischemic stroke. Neuroradiology. 2019;61:629–32. https://doi.org/10.1007/s00234-019-02213-0 .
doi: 10.1007/s00234-019-02213-0
pubmed: 30989243
Sun LR, Harrar D, Drocton G, Castillo-Pinto C, Felling R, Carpenter JL, Wernovsky G, McDougall CG, Gailloud P, Pearl MS. Mechanical thrombectomy for acute Ischemic stroke: considerations in children. Stroke. 2020;51:3174–81. https://doi.org/10.1161/strokeaha.120.029698 .
doi: 10.1161/strokeaha.120.029698
pubmed: 32912096
Sporns PB, Straeter R, Minnerup J, Wiendl H, Hanning U, Chapot R, Henkes H, Henkes E, Grams A, Dorn F, Nikoubashman O, Wiesmann M, Bier G, Weber A, Broocks G, Fiehler J, Brehm A, Psychogios M, Kaiser D, Yilmaz U, Morotti A, Marik W, Nolz R, Jensen-Kondering U, Schmitz B, Schob S, Beuing O, Goetz F, Trenkler J, Turowski B, Möhlenbruch M, Wendl C, Schramm P, Musolino P, Lee S, Schlamann M, Radbruch A, Rübsamen N, Karch A, Heindel W, Wildgruber M, Kemmling A. Does device selection impact recanalization rate and neurological outcome?: an analysis of the save childS study. Stroke. 2020;51:1182–9. https://doi.org/10.1161/strokeaha.119.028221 .
doi: 10.1161/strokeaha.119.028221
pubmed: 32114927
Sporns PB, Psychogios MN, Straeter R, Hanning U, Minnerup J, Chapot R, Henkes H, Henkes E, Grams A, Dorn F, Nikoubashman O, Wiesmann M, Bier G, Weber A, Broocks G, Fiehler J, Brehm A, Kaiser D, Yilmaz U, Morotti A, Marik W, Nolz R, Jensen-Kondering U, Braun M, Schob S, Beuing O, Goetz F, Trenkler J, Turowski B, Möhlenbruch M, Wendl C, Schramm P, Musolino PL, Lee S, Schlamann M, Radbruch A, Karch A, Rübsamen N, Wildgruber M, Kemmling A. Clinical diffusion mismatch to select pediatric patients for embolectomy 6 to 24 hours after stroke: an analysis of the save childS study. Neurology. 2021;96:e343–51. https://doi.org/10.1212/wnl.0000000000011107 .
doi: 10.1212/wnl.0000000000011107
pubmed: 33144517
pmcid: 7884981
Chabrier S, Ozanne A, Naggara O, Boulouis G, Husson B, Kossorotoff M. Hyperacute recanalization strategies and childhood stroke in the evidence age. Stroke. 2021;52:381–4. https://doi.org/10.1161/strokeaha.120.031133 .
doi: 10.1161/strokeaha.120.031133
pubmed: 33349018
Al-Mufti F, Schirmer CM, Starke RM, Chaudhary N, De Leacy R, Tjoumakaris SI, Haranhalli N, Abecassis IJ, Amuluru K, Bulsara KR, Hetts SW; SNIS Standards and Guidelines Committee and SNIS Board of Directors. Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg. 2022;14:1033–41. https://doi.org/10.1136/neurintsurg-2021-017888 .
doi: 10.1136/neurintsurg-2021-017888
pubmed: 34244337
Sporns PB, Kemmling A, Lee S, Fullerton H, Kunz WG, Wilson JL, Mackay MT, Steinlin M, Fiehler J, Psychogios M, Wildgruber M. A prospective multicenter registry on feasibility, safety, and outcome of endovascular recanalization in childhood stroke (save childS pro). Front Neurol. 2021;12:736092. https://doi.org/10.3389/fneur.2021.736092 .
doi: 10.3389/fneur.2021.736092
pubmed: 34539563
pmcid: 8446378