Recanalization Treatments for Pediatric Acute Ischemic Stroke in France

Kossorotoff, Manoëlle; Kerleroux, Basile; Boulouis, Grégoire; Husson, B.; Dong, Kim Tran; Eugène, François; Damaj, Léna; Ozanne, Augustin; Bellesme, Céline; Rolland, Anne; Bourcier, Romain; Triquenot-Bagan, Aude; Marnat, Gaultier; Neau, Jean‐Philippe; Joriot, Sylvie; Pérez, Alexandra; Guillen, Maud; Périvier, Maximilien; Audic, Frédérique; Hak, Jean-François; Denier, Christian; Naggara, Olivier

doi:10.1001/jamanetworkopen.2022.31343

Cited by 19 publications

(7 citation statements)

References 28 publications

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“…The 68 included articles 9–77 were published between 2001 and 2023 (Supporting Information S2: File 2). The main articles included case reports ( n = 48, 71 patients), prospective cohort studies ( n = 7, 215 patients), literature reviews ( n = 5), retrospective cohort studies ( n = 6, 209 patients), case series ( n = 1, nine patients), and systematic reviews ( n = 1, 235 patients).…”

Section: Resultsmentioning

confidence: 99%

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

Garcia,

Zuliani,

Mendes‐Chillof

et al. 2023

Annals of the Child Neurology Society

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BackgroundManagement of pediatric stroke is challenging because of the paucity of data supporting the efficacy of interventions. This scoping review details the treatments available for the acute phase of stroke in pediatric patients with arterial ischemic stroke.Summary of ReviewOverall, 68 relevant articles were published between 2001 and 2023. The primary study included 48 case reports (n = 48). Eleven articles reported the use of intravenous thrombolysis (IVT) with alteplase, eight used intra‐arterial (IA) alteplase, and 52 reported mechanical thrombectomy (MT). IVT was administered to 195 patients with a median of 5.5 h of stroke onset, and only four (2.0%) had intracranial hemorrhage after alteplase treatment. Of the 11 articles, nine used 0.9 mg/kg IVT administered as a 10% bolus, with the remaining 90% administered over one hour, and one study used 0.54 mg/kg. IA was performed in 17 patients with a median of 5.05 h of stroke onset, and three individuals (17.6%) had intracranial hemorrhage. Of the eight reports that document IA, two used 0.9 mg/kg; one each used 0.16 mg/kg, 0.1 mg/kg, 0.6 mg/kg, 100 mg/day, and 10 mg/day; and one article documented the use of urokinase 750 000 IU. MT was used in 434 and 215 individuals in a previous systematic review, with a median of 11.82 h of stroke onset, and only 2.9% had intracranial hemorrhage after the treatment. Stent retrievers were used in 33 reports (63.5%) and aspiration retrievers were mentioned in 15 articles (28.8%). Overall, the outcomes ranged from complete to moderate recovery for all modalities.ConclusionsIVT and MT are safer than IA; however, despite the lack of clinical trials, all modalities seem effective in improving clinical recovery. To guide clinical practice and determine better intervention modalities, clinicians should note the key messages from this review, such as using magnetic resonance imaging in the acute phase and identifying key risk factors and presenting symptoms.

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Section: Resultsmentioning

confidence: 99%

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

Garcia,

Zuliani,

Mendes‐Chillof

et al. 2023

Annals of the Child Neurology Society

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Section: Discussionmentioning

confidence: 99%

“…Variable selection criteria, differences in stroke etiology, enhanced neuroplasticity, and collaterals in children may account in part for this variance . However, selection bias is likely present, partly reflected in the disproportionate representation of adolescents in pediatric cohorts (42.5% to 76.3%) . Children younger than 5 years represented less than 6% of thrombectomy cases in the US inpatient analysis discussed above, despite forming 37.5% of the overall stroke cohort …”

Section: Discussionmentioning

confidence: 99%

“…More than 400 pediatric patients undergoing mechanical thrombectomy are reported in the literature, including case reports, case series, retrospective single-arm cohort studies, and national inpatient database analyses . Favorable clinical outcomes in these studies, equivalent to a modified Rankin Scale (mRS) score of 0 to 2, vary from 55.3% to 89.5% . Adolescents are disproportionately represented in these studies, relative to younger children .…”

Section: Introductionmentioning

confidence: 99%

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Association Between Thrombectomy and Functional Outcomes in Pediatric Patients With Acute Ischemic Stroke From Large Vessel Occlusion

et al. 2023

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ImportancePediatric large vessel occlusion (LVO) stroke has a poor natural history. However, uptake of mechanical thrombectomy is hindered by a lack of clinical trial data in children. A randomized clinical trial is not feasible due to small sample sizes and absence of equipoise.ObjectiveTo evaluate whether pediatric patients with acute LVO stroke who undergo thrombectomy have better clinical outcomes than matched patients managed conservatively.Design, Setting, and ParticipantsThis matched case-control study used pooled stroke registry data from 5 tertiary referral hospitals in Australia and Canada from January 2011 to April 2022. Patients were aged 1 month to younger than 18 years with acute LVO stroke. Pooled data identified 31 thrombectomy patients and 46 control patients. Five patients undergoing thrombectomy with basilar artery occlusion were excluded due to insufficient controls. Using a hierarchal matching system (site of occlusion, age group, side of occlusion, and sex), deidentified consensus matching of patients and controls was undertaken while blinded to clinical outcome. Data were analyzed from July to November 2022.ExposureIn the case cohort, mechanical thrombectomy was undertaken for management of acute LVO stroke. The control cohort received medical treatment only.Main Outcomes and MeasuresThe primary outcome was the functional clinical status 3 months following stroke, measured by the pediatric modified Rankin Scale (mRS). Clinical outcomes were compared between groups using ordinal regression analysis.ResultsOf 52 included patients, 31 (60%) were male, and the mean (SD) age was 10.3 (4.4) years. Matching was achieved for 26 children undergoing thrombectomy with 26 controls. There was no significant difference between groups for site or side of occlusion, age, sex, etiology, thrombolysis status, baseline Alberta Stroke Programme Early CT Score, or time since last seen well to presentation. Patients undergoing thrombectomy had superior clinical outcomes than control patients at 3 months on the pediatric mRS (odds ratio, 3.76; 95% CI, 1.32-10.67; P = .01). These superior outcomes were maintained at final follow-up (odds ratio, 3.65; 95% CI, 1.25-10.68; P = .02).Conclusions and RelevanceIn the absence of a randomized clinical trial, this case-control study demonstrates better clinical outcomes with thrombectomy than medical management alone for pediatric patients aged 2 to 18 years with anterior circulation LVO stroke.

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“…[1][2][3] Acute revascularization treatments, as intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT), have the potential to improve outcome. [4][5][6] However, the implementation of these treatments requires timely diagnosis of stroke which have proved challenging in children; the median time from symptom onset to diagnosis of pediatric AIS is more than 20 h. [7][8][9][10] Over the past decade, there has been increasing interest in developing pediatric stroke pathways to facilitate a fast…”

Section: Introductionmentioning

confidence: 99%

Acute triage of childhood stroke in Denmark

Bindslev

Hansen

Laugesen

et al. 2023

European Stroke Journal

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Objective: This 2-year observational study aimed to test the feasibility of implementing a pediatric stroke triage-setup that connected frontline providers with vascular neurologists and to examine final diagnoses in children triaged for suspected stroke. Methods: Prospective, consecutive registration of children with suspected stroke triaged by a team of vascular neurologists from Jan 1st, 2020 and through Dec 2021, Eastern Denmark (census 530,000 children). Based on the provided clinical information, the children were triaged to either assessment at the Comprehensive Stroke Center (CSC) in Copenhagen or to a pediatric department. All included children were retrospectively followed-up for clinical presentations and final diagnosis. Results: A total of 163 children with 166 suspected stroke events were triaged by the vascular neurologists. Cerebrovascular disease was present in 15 (9.0%) suspected stroke events; one child had intracerebral hemorrhage, one had subarachnoid hemorrhage, two children presented with three TIA events and nine children presented with 10 ischemic stroke events. Two children with ischemic stroke were eligible for acute revascularization treatment of which both were triaged to the CSC. The sensitivity of the triage by acute revascularization indication was 1.00 (95% confidence interval (95% CI): 0.15–1.00) and specificity 0.65 (95% CI: 0.57–0.73). Non-stroke neurological emergencies were present in 34 (20.5%) children, including seizures in 18 (10.8%) and acute demyelinating disorders in 7 (4.2%). Conclusion: Implementing regional triage-setup that connected frontline providers to vascular neurologists was feasible; this system was activated for the majority of children with ischemic stroke according to an expected incidence and led to identification of children eligible for revascularization treatments.

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Recanalization Treatments for Pediatric Acute Ischemic Stroke in France

Cited by 19 publications

References 28 publications

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

A scoping review of cerebral reperfusion therapies in childhood and adolescence with arterial ischemic stroke

Association Between Thrombectomy and Functional Outcomes in Pediatric Patients With Acute Ischemic Stroke From Large Vessel Occlusion

Acute triage of childhood stroke in Denmark

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