Does Device Selection Impact Recanalization Rate and Neurological Outcome? An Analysis of the Save ChildS Study

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Peter B. Sporns - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Ronald Straeter - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Jens Minnerup - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Heinz Wiendl - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Uta Hanning - , Universität Hamburg (Autor:in)
  • René Chapot - , Alfried Krupp Krankenhaus (Autor:in)
  • Hans Henkes - , Klinikum Stuttgart (Autor:in)
  • Elina Henkes - , Klinikum Stuttgart (Autor:in)
  • Astrid Grams - , Medizinische Universität Innsbruck (Autor:in)
  • Franziska Dorn - , Ludwig-Maximilians-Universität München (LMU) (Autor:in)
  • Omid Nikoubashman - , Rheinisch-Westfälische Technische Hochschule Aachen (Autor:in)
  • Martin Wiesmann - , Rheinisch-Westfälische Technische Hochschule Aachen (Autor:in)
  • Georg Bier - , Westfälische Wilhelms-Universität Münster, Eberhard Karls Universität Tübingen (Autor:in)
  • Anushe Weber - , Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH (Autor:in)
  • Gabriel Broocks - , Universität Hamburg (Autor:in)
  • Jens Fiehler - , Universität Hamburg (Autor:in)
  • Alex Brehm - , Georg-August-Universität Göttingen (Autor:in)
  • Marios Psychogios - , Georg-August-Universität Göttingen (Autor:in)
  • Daniel Kaiser - , Institut und Poliklinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden (Autor:in)
  • Umut Yilmaz - , Universität des Saarlandes (Autor:in)
  • Andrea Morotti - , IRCCS Fondazione Istituto Neurologico Casimiro Mondino - Pavia (Autor:in)
  • Wolfgang Marik - , Medizinische Universität Wien (Autor:in)
  • Richard Nolz - , Medizinische Universität Wien (Autor:in)
  • Ulf Jensen-Kondering - , Christian-Albrechts-Universität zu Kiel (CAU) (Autor:in)
  • Bernd Schmitz - , Westfälische Wilhelms-Universität Münster, Universität Ulm (Autor:in)
  • Stefan Schob - , Universität Leipzig (Autor:in)
  • Oliver Beuing - , Otto-von-Guericke-Universität Magdeburg (Autor:in)
  • Friedrich Goetz - , Medizinische Hochschule Hannover (MHH) (Autor:in)
  • Johannes Trenkler - , Kepler Universitätsklinikum (Autor:in)
  • Bernd Turowski - , Heinrich Heine Universität Düsseldorf (Autor:in)
  • Markus Möhlenbruch - , Universität Heidelberg (Autor:in)
  • Christina Wendl - , Universität Regensburg (Autor:in)
  • Peter Schramm - , Universitätsklinikum Schleswig-Holstein Campus Lübeck (Autor:in)
  • Patricia Musolino - , Harvard University (Autor:in)
  • Sarah Lee - , Stanford University (Autor:in)
  • Marc Schlamann - , Universität zu Köln (Autor:in)
  • Alexander Radbruch - , Universität Duisburg-Essen (Autor:in)
  • Nicole Rübsamen - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • André Karch - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Walter Heindel - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Moritz Wildgruber - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • André Kemmling - , Westpfalz-Klinikum GmbH, Universität Heidelberg (Autor:in)

Abstract

Background and Purpose - The recent Save ChildS study provides multicenter evidence for the use of mechanical thrombectomy in children with large vessel occlusion arterial ischemic stroke. However, device selection for thrombectomy may influence rates of recanalization, complications, and neurological outcomes, especially in pediatric patients of different ages. We, therefore, performed additional analyses of the Save ChildS data to investigate a possible association of different thrombectomy techniques and devices with angiographic and clinical outcome parameters. Methods - The Save ChildS cohort study (January 2000-December 2018) analyzed data from 27 European and United States stroke centers and included all pediatric patients (<18 years), diagnosed with arterial ischemic stroke who underwent endovascular recanalization. Patients were grouped into first-line contact aspiration (A Direct Aspiration First Pass Technique [ADAPT]) and non-ADAPT groups as well as different stent retriever size groups. Associations with baseline characteristics, recanalization rates (modified Treatment in Cerebral Infarction), complication rates, and neurological outcome parameters (Pediatric National Institutes of Health Stroke Scale after 24 hours and 7 days; modified Rankin Scale and Pediatric Stroke Outcome Measure at discharge, after 6 and 24 months) were investigated. Results - Seventy-three patients with a median age of 11.3 years were included. Currently available stent retrievers were used in 59 patients (80.8%), of which 4×20 mm (width×length) was the most frequently chosen size (36 patients =61%). A first-line ADAPT approach was used in 7 patients (9.6%), and 7 patients (9.6%) were treated with first-generation thrombectomy devices. In this study, a first-line ADAPT approach was neither associated with the rate of successful recanalization (ADAPT 85.7% versus 87.5% No ADAPT) nor with the complication rate or the neurological outcome. Moreover, there were no associations of stent retriever sizes with rates of recanalization, complication rates, or outcome parameters. Conclusions - Our study suggests that neurological outcomes are generally good regardless of any specific device selection and suggests that it is important to offer thrombectomy in eligible children regardless of technique or device selection.

Details

OriginalspracheEnglisch
Seiten (von - bis)1182-1189
Seitenumfang8
FachzeitschriftStroke
Jahrgang51
Ausgabenummer4
PublikationsstatusVeröffentlicht - 1 Apr. 2020
Peer-Review-StatusJa

Externe IDs

PubMed 32114927
ORCID /0000-0001-5258-0025/work/146644943

Schlagworte

Schlagwörter

  • child, cohort study, incidence, stent, thrombectomy