How do children fare compared with adults? Comparing relative outcomes after thrombectomy for acute ischemic stroke due to large-vessel occlusion

Matthew C Findlay; Ramesh Grandhi; Jayson R Nelson; Brandon Lucke-Wold; Muhammad Abdul Baker Chowdhury; Brian L Hoh; Jeffrey Steinberg; David Santiago-Dieppa; Alexander Khalessi; Daniel S Ikeda; Vijay M Ravindra

doi:10.1016/j.jstrokecerebrovasdis.2023.107350

How do children fare compared with adults? Comparing relative outcomes after thrombectomy for acute ischemic stroke due to large-vessel occlusion

J Stroke Cerebrovasc Dis. 2023 Nov;32(11):107350. doi: 10.1016/j.jstrokecerebrovasdis.2023.107350. Epub 2023 Sep 15.

Affiliations

¹ School of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
² Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Dr. E, Salt Lake City, UT 84132, USA.
³ Department of Neurosurgery, University of Florida, 1505 SW Archer Rd., Gainesville, FL 32608, USA.
⁴ Department of Neurosurgery, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
⁵ Department of Neurosurgery, Walter Reed National Military Medical Center, 4494 Palmer Rd. N, Bethesda, MD 20814, USA.
⁶ Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Dr. E, Salt Lake City, UT 84132, USA; Department of Neurosurgery, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Department of Neurological Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA 92134, USA. Electronic address: Vijay.Ravindra@hsc.utah.edu.

PMID: 37717373
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107350

Abstract

Objective: Safety and efficacy data for endovascular thrombectomy for acute ischemic stroke secondary to large-vessel occlusion in children are lacking compared with those for adults. We undertook an updated systematic review and meta-analysis of endovascular thrombectomy in children and compared their outcomes with adult data.

Methods: We searched PubMed, Medline, and EMBASE databases to identify prospective and retrospective studies describing patients <18 years treated with endovascular thrombectomy for acute ischemic stroke due to large-vessel occlusion.

Results: Eight pediatric studies were included (n = 192). Most patients were male (53.1 %), experienced anterior circulation large-vessel occlusion (81.8 %), and underwent endovascular thrombectomy by stent retreiver (70.7 %). The primary outcome was change in National Institutes of Health Stroke Scale score from presentation to 24 h after thrombectomy. Secondary outcomes included modified Rankin scale score improvement and 90-day score, recanalization rates, procedural complications, and mortality rates. After treatment, 88.5% of children had successful recanalization; the mean National Institutes of Health Stroke Scale score reduction was 7.37 (95 % CI 5.11-9.63, p < 0.01). The mean reduction of 6.87 (95 %CI 5.00-8.73, p < 0.01) for adults in 5 clinical trials (n = 634) was similar (Q_b = 0.11; p = 0.74). Children experienced higher rates of good neurological outcome (76.1 % vs. 46.0 %, p < 0.01) and revascularization (88.5 % vs. 72.3 %, p < 0.01), fewer major periprocedural complications (3.6 % vs. 30.4 %, p < 0.01), and lower mortality (1.0 % vs. 12.9 %, p < 0.01).

Conclusions: Endovascular thrombectomy may be safe and effective treatment for acute ischemic stroke due to large-vessel occlusion in children. The aggregated data demonstrated high rates of revascularization, favorable long-term neurological outcomes, and low complication rates.

Keywords: Acute ischemic stroke; Endovascular; Mechanical thrombectomy; Meta-analysis; Pediatric.