Sporns, Peter B. and Straeter, Ronald and Minnerup, Jens and Wiendl, Heinz and Hanning, Uta and Chapot, Rene and Henkes, Hans and Henkes, Elina and Grams, Astrid and Dorn, Franziska and Nikoubashman, Omid and Wiesmann, Martin and Bier, Georg and Weber, Anushe and Broocks, Gabriel and Fiehler, Jens and Brehm, Alex and Psychogios, Marios and Kaiser, Daniel and Yilmaz, Umut and Morotti, Andrea and Marik, Wolfgang and Nolz, Richard and Jensen-Kondering, Ulf and Schmitz, Bernd and Schob, Stefan and Beuing, Oliver and Goetz, Friedrich and Trenkler, Johannes and Turowski, Bernd and Moehlenbruch, Markus and Wendl, Christina and Schramm, Peter and Musolino, Patricia and Lee, Sarah and Schlamann, Marc and Radbruch, Alexander and Ruebsamen, Nicole and Karch, Andre and Heindel, Walter and Wildgruber, Moritz and Kemmling, Andre (2020) Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke The Save ChildS Study. JAMA NEUROLOGY, 77 (1). pp. 25-34. ISSN 2168-6149, 2168-6157
Full text not available from this repository. (Request a copy)Abstract
This cohort study examines the use of endovascular recanalization in pediatric patients with arterial ischemic stroke and clinical outcomes. Importance Randomized clinical trials have shown the efficacy of thrombectomy of large intracranial vessel occlusions in adults; however, any association of therapy with clinical outcomes in children is unknown. Objective To evaluate the use of endovascular recanalization in pediatric patients with arterial ischemic stroke. Design, Setting, and Participants This retrospective, multicenter cohort study, conducted from January 1, 2000, to December 31, 2018, analyzed the databases from 27 stroke centers in Europe and the United States. Included were all pediatric patients (<18 years) with ischemic stroke who underwent endovascular recanalization. Median follow-up time was 16 months. Exposures Endovascular recanalization. Main Outcomes and Measures The decrease of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score from admission to day 7 was the primary outcome (score range: 0 [no deficit] to 34 [maximum deficit]). Secondary clinical outcomes included the modified Rankin scale (mRS) (score range: 0 [no deficit] to 6 [death]) at 6 and 24 months and rate of complications. Results Seventy-three children from 27 participating stroke centers were included. Median age was 11.3 years (interquartile range [IQR], 7.0-15.0); 37 patients (51%) were boys, and 36 patients (49%) were girls. Sixty-three children (86%) received treatment for anterior circulation occlusion and 10 patients (14%) received treatment for posterior circulation occlusion; 16 patients (22%) received concomitant intravenous thrombolysis. Neurologic outcome improved from a median PedNIHSS score of 14.0 (IQR, 9.2-20.0) at admission to 4.0 (IQR, 2.0-7.3) at day 7. Median mRS score was 1.0 (IQR, 0-1.6) at 6 months and 1.0 (IQR, 0-1.0) at 24 months. One patient (1%) developed a postinterventional bleeding complication and 4 patients (5%) developed transient peri-interventional vasospasm. The proportion of symptomatic intracerebral hemorrhage events in the HERMES meta-analysis of trials with adults was 2.79 (95% CI, 0.42-6.66) and in Save ChildS was 1.37 (95% CI, 0.03-7.40). Conclusions and Relevance The results of this study suggest that the safety profile of thrombectomy in childhood stroke does not differ from the safety profile in randomized clinical trials for adults; most of the treated children had favorable neurologic outcomes. This study may support clinicians' practice of off-label thrombectomy in childhood stroke in the absence of high-level evidence. Question Is endovascular treatment in pediatric patients (<18 years) associated with ischemic stroke and the clinical outcome? Findings In this cohort study including 73 children, endovascular recanalization appeared to be safe with positive outcomes in a real-world setting (proportion of successful recanalization, 87%). The study findings suggest that neurologic outcomes of the children were mostly favorable and comparable with those noted in adult trials. Meaning This study appears to support the level of evidence in favor of endovascular recanalization in children with acute, large-vessel occlusion; a higher strength of recommendation may contribute to clinical outcome in children affected by arterial ischemic stroke.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ARTERIAL ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; THERAPY; METAANALYSIS; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Röntgendiagnostik |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 09 Apr 2021 08:39 |
| Last Modified: | 09 Apr 2021 08:39 |
| URI: | https://pred.uni-regensburg.de/id/eprint/45540 |
Actions (login required)
 |
View Item |
