Sudhakar Satti1, Jennifer Chen2, Thinesh Sivapatham1, Mahesh Jayaraman3, Darren Orbach4. 1. Department of Neurointerventional Surgery, Christiana Care Health System, Newark, Delaware, USA. 2. Sidney Kimmel Medical School, Philadelphia, Pennsylvania, USA. 3. Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA. 4. Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
Abstract
OBJECTIVE: Given recent strongly positive randomized controlled adult mechanical thrombectomy trials, we sought to perform a comprehensive review of available literature on IA pediatric stroke intervention, with a focus on modern mechanical devices. METHODS: PubMed search for pediatric patients undergoing IA treatment of acute ischemic stroke (AIS) using modern devices between 2008 and 2015. 29 patients were included in this analysis. RESULTS: Average age was 10.3 years, 74.1% male, middle cerebral and basilar arteries represented 89.6% of 36 occluded vessels, and average pediatric stroke scale score of 18.1. Average time from symptom onset to intervention was 8.8 hours and 13.8% of patients received IV tissue plasminogen activator prior to mechanical thrombectomy. Stent retrievers were used in 58.6% of cases, the Penumbra system in 34.5%, and the Merci device in 27.6%. Modified Thrombolysis In Cerebral Infarction 2b/3 recanalization was achieved in 75.9% of cases. There were no major adverse events related to the intervention, although one procedure was associated with device malfunction without a definite change in long-term outcome. The average modified Rankin Scale (mRS) score was <1 (0.86) at the longest available follow-up period, based on clinical description or provided mRS score. CONCLUSIONS: This study suggests that mechanical thrombectomy in pediatric patients presenting with high pediatric NIH Stroke Scale scores and proximal large vessel occlusion is associated with high recanalization rates and excellent clinical outcome, although this is a retrospective review and the sample size is too small to make any definitive conclusions. This study provides class IVC evidence that endovascular treatment of pediatric AIS increases the chance of a good clinical outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: Given recent strongly positive randomized controlled adult mechanical thrombectomy trials, we sought to perform a comprehensive review of available literature on IA pediatric stroke intervention, with a focus on modern mechanical devices. METHODS: PubMed search for pediatric patients undergoing IA treatment of acute ischemic stroke (AIS) using modern devices between 2008 and 2015. 29 patients were included in this analysis. RESULTS: Average age was 10.3 years, 74.1% male, middle cerebral and basilar arteries represented 89.6% of 36 occluded vessels, and average pediatric stroke scale score of 18.1. Average time from symptom onset to intervention was 8.8 hours and 13.8% of patients received IV tissue plasminogen activator prior to mechanical thrombectomy. Stent retrievers were used in 58.6% of cases, the Penumbra system in 34.5%, and the Merci device in 27.6%. Modified Thrombolysis In Cerebral Infarction 2b/3 recanalization was achieved in 75.9% of cases. There were no major adverse events related to the intervention, although one procedure was associated with device malfunction without a definite change in long-term outcome. The average modified Rankin Scale (mRS) score was <1 (0.86) at the longest available follow-up period, based on clinical description or provided mRS score. CONCLUSIONS: This study suggests that mechanical thrombectomy in pediatric patients presenting with high pediatric NIH Stroke Scale scores and proximal large vessel occlusion is associated with high recanalization rates and excellent clinical outcome, although this is a retrospective review and the sample size is too small to make any definitive conclusions. This study provides class IVC evidence that endovascular treatment of pediatric AIS increases the chance of a good clinical outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Peter B Sporns; Ronald Sträter; Jens Minnerup; Heinz Wiendl; Uta Hanning; René Chapot; Hans Henkes; Elina Henkes; Astrid Grams; Franziska Dorn; Omid Nikoubashman; Martin Wiesmann; Georg Bier; Anushe Weber; Gabriel Broocks; Jens Fiehler; Alex Brehm; Marios Psychogios; Daniel Kaiser; Umut Yilmaz; Andrea Morotti; Wolfgang Marik; Richard Nolz; Ulf Jensen-Kondering; Bernd Schmitz; Stefan Schob; Oliver Beuing; Friedrich Götz; Johannes Trenkler; Bernd Turowski; Markus Möhlenbruch; Christina Wendl; Peter Schramm; Patricia Musolino; Sarah Lee; Marc Schlamann; Alexander Radbruch; Nicole Rübsamen; André Karch; Walter Heindel; Moritz Wildgruber; André Kemmling Journal: JAMA Neurol Date: 2020-01-01 Impact factor: 18.302
Authors: D Andrew Wilkinson; Aditya S Pandey; Hugh J Garton; Luis Savastano; Julius Griauzde; Neeraj Chaudhary; Joseph J Gemmete Journal: BMJ Case Rep Date: 2017-10-13
Authors: Peter B Sporns; Marios-Nikos Psychogios; Ronald Straeter; Uta Hanning; Jens Minnerup; René Chapot; Hans Henkes; Elina Henkes; Astrid Grams; Franziska Dorn; Omid Nikoubashman; Martin Wiesmann; Georg Bier; Anushe Weber; Gabriel Broocks; Jens Fiehler; Alex Brehm; Daniel Kaiser; Umut Yilmaz; Andrea Morotti; Wolfgang Marik; Richard Nolz; Ulf Jensen-Kondering; Michael Braun; Stefan Schob; Oliver Beuing; Friedrich Goetz; Johannes Trenkler; Bernd Turowski; Markus Möhlenbruch; Christina Wendl; Peter Schramm; Patricia L Musolino; Sarah Lee; Marc Schlamann; Alexander Radbruch; André Karch; Nicole Rübsamen; Moritz Wildgruber; André Kemmling Journal: Neurology Date: 2020-11-03 Impact factor: 9.910