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

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Peter B. Sporns - , University of Münster (Author)
  • Ronald Straeter - , University of Münster (Author)
  • Jens Minnerup - , University of Münster (Author)
  • Heinz Wiendl - , University of Münster (Author)
  • Uta Hanning - , University of Hamburg (Author)
  • René Chapot - , Alfried Krupp Krankenhaus (Author)
  • Hans Henkes - , Klinikum Stuttgart (Author)
  • Elina Henkes - , Klinikum Stuttgart (Author)
  • Astrid Grams - , Innsbruck Medical University (Author)
  • Franziska Dorn - , Ludwig Maximilian University of Munich (Author)
  • Omid Nikoubashman - , RWTH Aachen University (Author)
  • Martin Wiesmann - , RWTH Aachen University (Author)
  • Georg Bier - , University of Münster, University of Tübingen (Author)
  • Anushe Weber - , University Hospital Knappschaftskrankenhaus Bochum GmbH (Author)
  • Gabriel Broocks - , University of Hamburg (Author)
  • Jens Fiehler - , University of Hamburg (Author)
  • Alex Brehm - , University of Göttingen (Author)
  • Marios Psychogios - , University of Göttingen (Author)
  • Daniel Kaiser - , Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology (Author)
  • Umut Yilmaz - , Saarland University (Author)
  • Andrea Morotti - , IRCCS Fondazione Istituto Neurologico Casimiro Mondino - Pavia (Author)
  • Wolfgang Marik - , Medical University of Vienna (Author)
  • Richard Nolz - , Medical University of Vienna (Author)
  • Ulf Jensen-Kondering - , Kiel University (Author)
  • Bernd Schmitz - , University of Münster, Ulm University (Author)
  • Stefan Schob - , Leipzig University (Author)
  • Oliver Beuing - , Otto von Guericke University Magdeburg (Author)
  • Friedrich Goetz - , Hannover Medical School (MHH) (Author)
  • Johannes Trenkler - , Kepler University Hospital (Author)
  • Bernd Turowski - , Heinrich Heine University Düsseldorf (Author)
  • Markus Möhlenbruch - , Heidelberg University  (Author)
  • Christina Wendl - , University of Regensburg (Author)
  • Peter Schramm - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Patricia Musolino - , Harvard University (Author)
  • Sarah Lee - , Stanford University (Author)
  • Marc Schlamann - , University of Cologne (Author)
  • Alexander Radbruch - , University of Duisburg-Essen (Author)
  • Nicole Rübsamen - , University of Münster (Author)
  • André Karch - , University of Münster (Author)
  • Walter Heindel - , University of Münster (Author)
  • Moritz Wildgruber - , University of Münster (Author)
  • André Kemmling - , Westpfalz-Klinikum GmbH, Heidelberg University  (Author)

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

Original languageEnglish
Pages (from-to)1182-1189
Number of pages8
JournalStroke
Volume51
Issue number4
Publication statusPublished - 1 Apr 2020
Peer-reviewedYes

External IDs

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

Keywords

Keywords

  • child, cohort study, incidence, stent, thrombectomy