Feasibility, Safety and Outcome of Recanalisation Treatment in Childhood Stroke.

Bigi, Sandra; Dulcey, Andrea Sara; Gralla, Jan; Bernasconi, Corrado Angelo; Melliger, Amber Tamsin; Datta, Alexandre N; Arnold, Marcel; Kaesmacher, Johannes; Fluss, Joel; Hackenberg, Annette; Maier, Oliver; Weber, Johannes; Poloni, Claudia; Fischer, Urs; Steinlin, Maja (2018). Feasibility, Safety and Outcome of Recanalisation Treatment in Childhood Stroke. Annals of neurology, 83(6), pp. 1125-1132. Wiley-Blackwell 10.1002/ana.25242

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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 Retrospective study (01/2000-12/2015) of a multicenter, population-based consecutive cohort of patients aged 1 month - 16 years diagnosed with AIS presenting with a 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 intraarterial 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 a pedNIHSS of ≥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 versus 6.9 years, p=0.01) and more severely affected (median pedNIHSS 13.5 versus 8.0, p<0.001). Death and bleeding complications did not differ between the two groups. Median (IQR) 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. This article is protected by copyright. All rights reserved.

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