Sporns, Peter B. and Bhatia, Kartik and Abruzzo, Todd and Pabst, Lisa and Fraser, Stuart and Chung, Melissa G. and Lo, Warren and Othman, Ahmed and Steinmetz, Sebastian and Jensen-Kondering, Ulf and Schob, Stefan and Kaiser, Daniel P. O. and Marik, Wolfgang and Wendl, Christina and Kleffner, Ilka and Henkes, Hans and Kraehling, Hermann and Nguyen-Kim, Thi Dan Linh and Chapot, Rene and Yilmaz, Umut and Wang, Furene and Hafeez, Muhammad Ubaid and Requejo, Flavio and Limbucci, Nicola and Kauffmann, Birgit and Moehlenbruch, Markus and Nikoubashman, Omid and Schellinger, Peter D. and Musolino, Patricia and Alawieh, Ali and Wilson, Jenny and Grieb, Dominik and Gersing, Alexandra S. and Liebig, Thomas and Olivieri, Martin and Schwabova, Jaroslava Paulasova and Tomek, Ales and Papanagiotou, Panagiotis and Boulouis, Gregoire and Naggara, Olivier and Fox, Christine K. and Orlov, Kirill and Kuznetsova, Alexandra and Parra-Farinas, Carmen and Muthusami, Prakash and Regenhardt, Robert W. and Dmytriw, Adam A. and Burkard, Tanja and Martinez, Mesha and Brechbuhl, Daniel and Steinlin, Maja and Sun, Lisa R. and Hassan, Ameer E. and Kemmling, Andre and Lee, Sarah and Fullerton, Heather J. and Fiehler, Jens and Psychogios, Marios-Nikos and Wildgruber, Moritz (2024) Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study. LANCET CHILD & ADOLESCENT HEALTH, 8 (12). pp. 882-890. ISSN 2352-4642,
Full text not available from this repository. (Request a copy)Abstract
Background Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke. Methods In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (+/- 10 days) post-stroke, assessed by the Wilcoxon rank test (alpha=0<middle dot>05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960. Findings Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6-14]), and 91 patients received best medical treatment (6 years [3-12]; p<0<middle dot>0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10-19) in the endovascular thrombectomy group and 9 (5-13) in the best medical treatment group (p<0<middle dot>0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0-0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0<middle dot>020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0<middle dot>89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0<middle dot>029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day median mRS scores (2 [IQR 1-3] vs 2 [1-4]; p=0<middle dot>074). Interpretation Clinical centres tended to select children with more severe strokes (higher PedNIHSS score) for endovascular thrombectomy. Nevertheless, endovascular thrombectomy was associated with improved functional outcomes in paediatric patients with large-vessel or medium-vessel occlusions compared with best medical treatment. Future studies need to investigate whether the positive effect of endovascular thrombectomy is confined to older and more severely affected children. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DIAGNOSIS; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Zentrum für Neuroradiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 23 Jul 2025 09:20 |
| Last Modified: | 23 Jul 2025 09:20 |
| URI: | https://pred.uni-regensburg.de/id/eprint/65754 |
Actions (login required)
 |
View Item |
