Laurence Tabone1, Nicolas Mediamolle1, Celine Bellesme1, Fabrice Lesage1, David Grevent1, Augustin Ozanne1, Olivier Naggara1, Beatrice Husson1, Isabelle Desguerre1, Catherine Lamy1, Christian Denier1, Manoelle Kossorotoff2. 1. From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N) and Department of Neurology (C.L.), INSERM UMR-S894, Université Paris-Descartes, Sainte-Anne Hospital, France. 2. From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N) and Department of Neurology (C.L.), INSERM UMR-S894, Université Paris-Descartes, Sainte-Anne Hospital, France. manoelle.kossorotoff@aphp.fr.
Abstract
BACKGROUND AND PURPOSE: To evaluate hyperacute management of pediatric arterial ischemic stroke, setting up dedicated management pathways is the first recommended step to prove the feasibility and safety of such treatments. A regional pediatric stroke alert protocol including 2 centers in the Paris-Ile-de-France area, France, was established. METHODS: Consecutive pediatric patients (28 days-18 years) with confirmed arterial ischemic stroke who had acute recanalization treatment (intravenous r-tPA [recombinant tissue-type plasminogen activator], endovascular procedure, or both) according to the regional pediatric stroke alert were retrospectively reviewed during a 40-month period. RESULTS: Thirteen children, aged 3.7 to 16.6 years, had recanalization treatment. Median time from onset to magnetic resonance imaging was 165 minutes (150-300); 9 out of 13 had large-vessel occlusion. Intravenous r-tPA was used in 11 out of 13 patients, with median time from onset to treatment of 240 minutes (178-270). Endovascular procedure was performed in patients time-out for intravenous r-tPA (n=2) or after intravenous r-tPA inefficiency (n=2). No intracranial or peripheral bleeding was reported. One patient died of malignant stroke; outcome was favorable in 11 out of 12 survivors (modified Rankin Scale score 0-2). CONCLUSIONS: Hyperacute recanalization treatment in pediatric stroke, relying on common protocols and adult/pediatric ward collaboration, is feasible. Larger systematic case collection is encouraged.
BACKGROUND AND PURPOSE: To evaluate hyperacute management of pediatric arterial ischemic stroke, setting up dedicated management pathways is the first recommended step to prove the feasibility and safety of such treatments. A regional pediatric stroke alert protocol including 2 centers in the Paris-Ile-de-France area, France, was established. METHODS: Consecutive pediatric patients (28 days-18 years) with confirmed arterial ischemic stroke who had acute recanalization treatment (intravenous r-tPA [recombinant tissue-type plasminogen activator], endovascular procedure, or both) according to the regional pediatric stroke alert were retrospectively reviewed during a 40-month period. RESULTS: Thirteen children, aged 3.7 to 16.6 years, had recanalization treatment. Median time from onset to magnetic resonance imaging was 165 minutes (150-300); 9 out of 13 had large-vessel occlusion. Intravenous r-tPA was used in 11 out of 13 patients, with median time from onset to treatment of 240 minutes (178-270). Endovascular procedure was performed in patients time-out for intravenous r-tPA (n=2) or after intravenous r-tPA inefficiency (n=2). No intracranial or peripheral bleeding was reported. One patient died of malignant stroke; outcome was favorable in 11 out of 12 survivors (modified Rankin Scale score 0-2). CONCLUSIONS: Hyperacute recanalization treatment in pediatric stroke, relying on common protocols and adult/pediatric ward collaboration, is feasible. Larger systematic case collection is encouraged.
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: Peter B Sporns; Heather J Fullerton; Sarah Lee; Helen Kim; Warren D Lo; Mark T Mackay; Moritz Wildgruber Journal: Nat Rev Dis Primers Date: 2022-02-24 Impact factor: 52.329
Authors: Peter B Sporns; André Kemmling; Uta Hanning; Jens Minnerup; Ronald Sträter; Thomas Niederstadt; Walter Heindel; Moritz Wildgruber Journal: J Am Heart Assoc Date: 2019-03-05 Impact factor: 5.501