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Abstract
Background Endovascular mechanical thrombectomy (EVT) is a standard treatment for acute ischemic stroke secondary to large-vessel occlusion (LVO) in adults. Although EVT is performed in children, data regarding safety and efficacy is less robust.
Purpose We sought to provide an updated systematic review and meta-analysis of EVT in children and compare the outcomes with adult data.
Methods A systematic review and meta-analysis of EVT in children was performed. The primary outcome was change in National Institutes of Health Stroke Scale (NIHSS) score from presentation to 24 hours after EVT. Secondary outcomes included improvement in modified Rankin scale (mRS) score, 90-day mRS score, recanalization rates, procedural complications, and mortality rates. NIHSS reduction, 90-day mRS score, and complications in children were compared with those of a large adult cohort.
Results Eight studies on pediatric EVT were included (n=192 children). Most patients were male (53.1%), and most experienced an anterior circulation LVO (81.8%). Stent retrievers were most commonly used (70.7%). After EVT, 88.5% of children had successful recanalization. The mean NIHSS score reduction was 7.37 (95% CI 5.11-9.63, p<0.01) (figure 1A). Assessment of adult data from 5 clinical trials (634 patients) demonstrated a mean NIHSS score reduction of 6.87 (95% CI 5.00-8.73, p<0.01) (figure 1B); the magnitude of NIHSS reduction was similar between adults and children (Qb=0.11; p=0.74) (figure 1C). Children experienced a higher rate of a good neurological outcome (90-day mRS score 0-2) (76.1% vs. 46.0%, p<0.01), greater revascularization rate (88.5% vs. 72.3%, p<0.01) fewer major periprocedural complications (4.7% vs. 30.4%, p<0.01), and lower mortality rates (1.0% vs. 12.9%, p<0.01).
Conclusions EVT is a safe and effective treatment for AIS due to LVO in children. The immediate improvement in NIHSS score seen after EVT in pediatric patients is similar to adults; the data suggest higher rates of favorable long-term neurological outcomes, higher revascularization rates, and lower complication rates, endorsing consideration of this intervention in children presenting with LVO.
Disclosures M. Findlay: None. R. Grandhi: None. J. Nelson: None. B. Lucke-Wold: None. M. Chowdhury: None. B. Hoh: None. J. Steinberg: None. D. Santiago-Dieppa: None. A. Khalessi: None. D. Ikeda: None. V. Ravindra: None.