Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study

Amlie‐Lefond, Catherine; deVeber, Gabrielle; Chan, Anthony; Benedict, Susan; Bernard, Timothy J.; Carpenter, Jessica; Dowling, Michael M.; Fullerton, Heather J.; Hovinga, Collin A.; Kirton, Adam; Lo, Warren; Zamel, Khaled M.; Ichord, Rebecca

doi:10.1016/s1474-4422(09)70106-1

Cited by 172 publications

(127 citation statements)

References 39 publications

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“…In-hospital mortality in the rt-PA group was 0% vs 4.8% in the no-rt-PA group 33 . The authors reported no increase in mortality in the rt-PA group consistent with previously published data 36,45 . Although the guidelines are still missing, some stroke centres are planning to define the safety guidelines for rt-PA administration in children with AIS (ref.…”

Section: Discussionsupporting

confidence: 89%

Ischemic stroke in paediatrics - narrative review of the literature and two cases

Klučka¹,

Štourač²,

Štoudek³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Stroke is a rare condition in childhood with an estimated incidence of between 1.3-13/100.000 patients. Clinical manifestation and risk factors for paediatric stroke are different from those of adults. The uncommon incidence, age-associated difference and plethora of clinical symptoms make the diagnosis of such strokes extremely difficult and often delayed. The history and clinical examination should point to diseases or predisposing factors. Neuroimaging (DWI MR) is the golden standard for diagnosis of paediatric stroke and other investigations can be considered according to the clinical condition. Despite advances in paediatric stroke research and clinical care, questions remain unanswered regarding acute treatment, secondary prevention and rehabilitation. The treatment recommendations are mainly extrapolated from studies on adult populations. In the review authors summarized the clinical characteristics and diagnostic steps for stroke in children/adolescents based on the most recent international guidelines and practical directions for recognising and managing the child/adolescent with stroke in paediatric emergency. In the two case reports, we describe the clinical course in both stroke patients.

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Section: Discussionsupporting

confidence: 89%

Ischemic stroke in paediatrics - narrative review of the literature and two cases

Klučka¹,

Štourač²,

Štoudek³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…These have described the use of alteplase in childhood arterial ischemic stroke and the predictors of antithrombotic treatment in neonatal cerebral sinovenous thrombosis (CSVT) [131,132]. These have highlighted the variability and inconsistencies in different areas of pediatric stroke practice and underscored the lack of evidence-based guidance in pediatric stroke management.…”

Section: Current Developmentsmentioning

confidence: 99%

“…These have highlighted the variability and inconsistencies in different areas of pediatric stroke practice and underscored the lack of evidence-based guidance in pediatric stroke management. Although there are currently no recommendations for its use, alteplase is regularly given to children at time intervals that fall outside the recommended adult guidelines in varying doses [131]. Development-related differences in the coagulation system, in stroke pathophysiology, and in neuropharmacology limit the ability to directly translate adult experience to pediatrics [133].…”

Section: Current Developmentsmentioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

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Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

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“…However, despite age-related differences in cerebrovascular, coagulation, and fibrinolytic systems in children 13 and lack of established guidelines for thrombolytics in childhood AIS, 14 numerous cases have been reported in the literature. 13 The Thrombolysis in Pediatric Stroke (TIPS) trial will establish the safety and feasibility of IV tPA in children with AIS, 15 but there have been no such studies addressing the safety or efficacy of IA thrombolysis or endovascular therapies in the management of pediatric AIS, and no formal guidelines exist.The objectives of this report are to summarize the reported literature on the use of endovascular thrombolytic therapies in children with AIS and to address the potential role of endovascular techniques in the management of AIS in children.METHODS All reported cases of pediatric AIS in the English-language literature that were treated with endovascular thrombolytic strategies were reviewed. Cases were identified by a PubMed search from 1965 to 2011 using these key words: child, pediatric, stroke, …”

mentioning

confidence: 99%

“…Moreover, pediatric AIS occurs in the context of underlying age-related differences in cerebrovascular anatomy and physiology 13,15 …”

mentioning

confidence: 99%

Endovascular therapy in children with acute ischemic stroke

2012

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This review provides a summary of the currently available data pertaining to the interventional management of acute ischemic stroke in children. The literature is scarce and is lacking muchneeded prospective trials. No study in the literature on the well-established systemic or local thrombolysis trials has included children. Mechanical thrombectomy trials using clot retriever devices have also excluded patients younger than 18 years. The current review is limited to case series of interventional acute ischemic stroke therapy in children and the potential future of endovascular ischemic stroke therapy in this patient population. Recommendations in this review represent the opinion of the authors, based on review of the limited literature covering endovascular acute ischemic stroke therapy in children. Neurology ® 2012;79 (Suppl 1):S158-S164 GLOSSARY AIS ϭ acute ischemic stroke; IA ϭ intra-arterial; ICA ϭ internal carotid artery; MCA ϭ middle cerebral artery; TIPS ϭ Thrombolysis in Pediatric Stroke; tPA ϭ tissue plasminogen activator.The principal goal of acute endovascular therapy for arterial ischemic stroke (AIS) is prompt recanalization of the occluded vessel and restoration of blood flow to the ischemic brain. In adults with AIS, IV administration of tissue plasminogen activator (tPA) within 3 hours of symptom onset is associated with improved 3-month 1 and 1-year clinical outcomes 2 and is the only approved medical treatment for this condition.3 More recent studies demonstrate safety and suggest benefit from IV tPA up to 4.5 hours after symptom onset. 4 Patients presenting outside this therapeutic window or those with contraindications to IV tPA may benefit from intra-arterial (IA) pharmacological thrombolysis 5,6 or mechanical thrombolysis/thrombectomy with a variety of approved or investigational endovascular devices. [7][8][9] Following AIS, 3% to 6% of children will die, 25% will have recurrent stroke, and 70% will survive with life-long disability, 10 -12 resulting in decades of enormous personal and societal burden. There are no published clinical trials examining IV, IA, or endovascular mechanical thrombolytic strategies in children with AIS. However, despite age-related differences in cerebrovascular, coagulation, and fibrinolytic systems in children 13 and lack of established guidelines for thrombolytics in childhood AIS, 14 numerous cases have been reported in the literature. 13 The Thrombolysis in Pediatric Stroke (TIPS) trial will establish the safety and feasibility of IV tPA in children with AIS, 15 but there have been no such studies addressing the safety or efficacy of IA thrombolysis or endovascular therapies in the management of pediatric AIS, and no formal guidelines exist.The objectives of this report are to summarize the reported literature on the use of endovascular thrombolytic therapies in children with AIS and to address the potential role of endovascular techniques in the management of AIS in children.METHODS All reported cases of pediatric AIS in the English-language liter...

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Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study

Cited by 172 publications

References 39 publications

Ischemic stroke in paediatrics - narrative review of the literature and two cases

Ischemic stroke in paediatrics - narrative review of the literature and two cases

Pediatric Neurocritical Care

Endovascular therapy in children with acute ischemic stroke

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