Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Peter B. Sporns - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Ronald Sträter - , 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 - , Universität Ulm (Autor:in)
  • Stefan Schob - , Universität Leipzig (Autor:in)
  • Oliver Beuing - , Otto-von-Guericke-Universität Magdeburg (Autor:in)
  • Friedrich Götz - , 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 - , Westfälische Wilhelms-Universität Münster (Autor:in)

Abstract

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.

Details

OriginalspracheEnglisch
Seiten (von - bis)25-34
Seitenumfang10
FachzeitschriftJAMA neurology
Jahrgang77
Ausgabenummer1
PublikationsstatusVeröffentlicht - Jan. 2020
Peer-Review-StatusJa

Externe IDs

PubMed 31609380
ORCID /0000-0001-5258-0025/work/146644941

Schlagworte

ASJC Scopus Sachgebiete