Vijay M Ravindra1,2,3, Matthew Alexander4, Philipp Taussky1, Robert J Bollo1, Ameer E Hassan5,6, Jonathan P Scoville1, Julius Griauzde7, Al-Wala Awad1, Mouhammad Jumaa8,9, Syed Zaidi8,9, Jonathan J Lee10, Muhammad Ubaid Hafeez11, Fábio A Nascimento11, Melissa A LoPresti2, William T Couldwell1, Steven W Hetts12, Sandi K Lam2, Peter Kan2, Ramesh Grandhi1. 1. Department of Neurosurgery, University of Utah School of Medicine, Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah. 2. Department of Neurosurgery, Baylor College of Medicine, Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas. 3. Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California. 4. Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah. 5. University of Texas Health Science Center-San Antonio, Valley Baptist Medical Center, Harlingen, Texas. 6. Department of Neurology, University of Texas, Rio Grande Valley, Harlingen, Texas. 7. Department of Radiology, University of Michigan School of Medicine; Ann Arbor, Michigan. 8. Department of Neurology, University of Toledo, Toledo, Ohio. 9. ProMedica Russell J. Ebeid Children's Hospital, Toledo, Ohio. 10. Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas. 11. Department of Neurology, Baylor College of Medicine, Houston, Texas. 12. Department of Radiology, University of California - San Francisco, San Francisco, California.
Abstract
BACKGROUND: Endovascular thrombectomy is a promising treatment for acute ischemic stroke in children, but outcome and technical data in pediatric patients with large-vessel occlusions are lacking. OBJECTIVE: To assess technical and clinical outcomes of thrombectomy in pediatric patients. METHODS: We undertook a retrospective cohort study of pediatric patients who experienced acute ischemic stroke from April 2017 to April 2019 who had immediate, 30-, and 90-d follow-up. Patients were treated with endovascular thrombectomy at 5 US pediatric tertiary care facilities. We recorded initial and postprocedural modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b, initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and pediatric modified Rankin scale (mRS) score 0 to 2 at 90 d. RESULTS: There were 23 thrombectomies in 21 patients (mean age 11.6 ± 4.9 yr, median 11.5, range 2.1-19; 52% female). A total of 19 (83%) thrombectomies resulted in mTICI grade ≥ 2b recanalization. The median PedNIHSS score was 13 on presentation (range 4-33) and 2 (range 0-26) at discharge (mean reduction 11.3 ± 6.1). A total of 14 (66%) patients had a mRS score of 0 to 2 at 30-d follow-up; 18/21 (86%) achieved that by 90 d. The median mRS was 1 (range 0-4) at 30 d and 1 (range 0-5) at 90 d. One patient required a blood transfusion after thrombectomy. CONCLUSION: In this large series of pediatric patients treated with endovascular thrombectomy, successful recanalization was accomplished via a variety of approaches with excellent clinical outcomes; further prospective longitudinal study is needed.
BACKGROUND: Endovascular thrombectomy is a promising treatment for acute ischemic stroke in children, but outcome and technical data in pediatric patients with large-vessel occlusions are lacking. OBJECTIVE: To assess technical and clinical outcomes of thrombectomy in pediatric patients. METHODS: We undertook a retrospective cohort study of pediatric patients who experienced acute ischemic stroke from April 2017 to April 2019 who had immediate, 30-, and 90-d follow-up. Patients were treated with endovascular thrombectomy at 5 US pediatric tertiary care facilities. We recorded initial and postprocedural modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b, initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and pediatric modified Rankin scale (mRS) score 0 to 2 at 90 d. RESULTS: There were 23 thrombectomies in 21 patients (mean age 11.6 ± 4.9 yr, median 11.5, range 2.1-19; 52% female). A total of 19 (83%) thrombectomies resulted in mTICI grade ≥ 2b recanalization. The median PedNIHSS score was 13 on presentation (range 4-33) and 2 (range 0-26) at discharge (mean reduction 11.3 ± 6.1). A total of 14 (66%) patients had a mRS score of 0 to 2 at 30-d follow-up; 18/21 (86%) achieved that by 90 d. The median mRS was 1 (range 0-4) at 30 d and 1 (range 0-5) at 90 d. One patient required a blood transfusion after thrombectomy. CONCLUSION: In this large series of pediatric patients treated with endovascular thrombectomy, successful recanalization was accomplished via a variety of approaches with excellent clinical outcomes; further prospective longitudinal study is needed.
Authors: Vijay M Ravindra; Frederik Denorme; Matthew D Alexander; Robert A Campbell; Ramesh Grandhi Journal: Interv Neuroradiol Date: 2022-04-21 Impact factor: 1.764