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.

No abstract

No abstract

Background: Idiopathic intracranial hypertension (IIH) is an increasingly prevalent disease bearing the risk of visual impairment and affecting quality of life. Clinical presentation and outcome are heterogeneous. Large, well-characterized cohorts are scarce.Here, we describe the Vienna-Idiopathic-Intracranial-Hypertension (VIIH) database aiming to characterize the clinical spectrum, diagnostic findings, therapeutic management, and outcome of IIH.Methods: We identified patients with IIH according to the modified Dandy criteria who were treated at our center between 2014 and 2021. Methodology and structure of the VIIH database are described in detail including demographics, clinical parameters, magnetic resonance imaging, optical coherence tomography, transorbital sonography, treatment, and outcome.Results: Of 113 patients, 89% were female (mean age 32.3 years). Median body mass index (BMI) was 31.8, with 85% overweight (BMI>25). Papilledema was found in 95% with 5% classified as IIH without papilledema. Headache was present in 84% and showed migrainous features in 43%. Median opening pressure in lumbar puncture was 31cmH2O.Pharmacotherapy (predominantly acetazolamide) was established in 99%, 56% required at least one therapeutic lumbar puncture and 13% surgical intervention. After a median follow-up of 3.7 years, 43% had not achieved significant weight loss, papilledema was present in 59% and headache in 76% (58% improved). Comparing initial presentation to follow-up, perimetry was abnormal in 67% vs. 50% (8% worsened, 24% improved) and transorbital sonography in 87% vs. 65% with a median optic nerve sheath diameter of 5.4mm vs. 4.9mm. Median peripapillary retinal nerve fiber layer thickness had decreased from 199µm to 99µm and ganglion cell layer volume from 1.13mm3 to 1.05mm3.Conclusions: The VIIH database constitutes a large representative cohort, characterizing IIH-related symptoms, diagnostic findings, treatment, and outcome parameters and emphasizing substantial long-term sequelae of IIH. Future analyses will aim to refine phenotyping and identify factors predicting outcome.

ObjectiveTo determine whether thrombectomy is safe in children up to 24 hours after onset of symptoms when selected by mismatch between clinical deficit and infarct.MethodsA secondary analysis of the Save ChildS Study (01/2000–12/2018) was performed, including all pediatric patients (<18 years), diagnosed with Arterial Ischemic Stroke who underwent endovascular recanalization at 27 European and United States stroke centers. Patients were included if they had a relevant mismatch between clinical deficit and infarct.ResultsTwenty children with a median age of 10.5 years (interquartile range; IQR 7–14.6) were included. Of those 7 were male (35%) and median time from onset to thrombectomy was 9.8 hours (IQR 7.8–16.2). Neurologic outcome improved from a median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score of 12.0 (IQR, 8.8–20.3) at admission to 2.0 (IQR, 1.2–6.8) at day 7. Median modified Rankin Scale (mRS) score was 1.0 (IQR, 0–1.6) at 3 months and 0.0 (IQR, 0–1.0) at 24 months. One patient developed transient peri-interventional vasospasm; no other complications were observed. A comparison of the mRS to the mRS in the DAWN and DEFUSE 3 trials revealed a higher proportion of good outcomes in the pediatric compared to the adult study population.ConclusionsThrombectomy in pediatric ischemic stroke in an extended time window of up to 24 hours after onset of symptoms seems safe and neurological outcomes are generally good, if patients are selected by a mismatch between clinical deficit and infarct.Classification of evidenceThis study provides Class IV evidence that for children with acute ischemic stroke with a mismatch between clinical deficit and infarct size, thrombectomy is safe.