• Neurosurgery · Dec 2020

    Multicenter Study

    Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke: A Multi-Institutional Experience of Technical and Clinical Outcomes.

    • Vijay M Ravindra, Matthew Alexander, Philipp Taussky, Robert J Bollo, Ameer E Hassan, Jonathan P Scoville, Julius Griauzde, Al-Wala Awad, Mouhammad Jumaa, Syed Zaidi, Jonathan J Lee, Muhammad Ubaid Hafeez, Fábio A Nascimento, Melissa A LoPresti, William T Couldwell, Steven W Hetts, Sandi K Lam, Peter Kan, and Ramesh Grandhi.
    • Department of Neurosurgery, University of Utah School of Medicine, Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah.
    • Neurosurgery. 2020 Dec 15; 88 (1): 46-54.

    BackgroundEndovascular thrombectomy is a promising treatment for acute ischemic stroke in children, but outcome and technical data in pediatric patients with large-vessel occlusions are lacking.ObjectiveTo assess technical and clinical outcomes of thrombectomy in pediatric patients.MethodsWe undertook a retrospective cohort study of pediatric patients who experienced acute ischemic stroke from April 2017 to April 2019 who had immediate, 30-, and 90-d follow-up. Patients were treated with endovascular thrombectomy at 5 US pediatric tertiary care facilities. We recorded initial and postprocedural modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b, initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and pediatric modified Rankin scale (mRS) score 0 to 2 at 90 d.ResultsThere were 23 thrombectomies in 21 patients (mean age 11.6 ± 4.9 yr, median 11.5, range 2.1-19; 52% female). A total of 19 (83%) thrombectomies resulted in mTICI grade ≥ 2b recanalization. The median PedNIHSS score was 13 on presentation (range 4-33) and 2 (range 0-26) at discharge (mean reduction 11.3 ± 6.1). A total of 14 (66%) patients had a mRS score of 0 to 2 at 30-d follow-up; 18/21 (86%) achieved that by 90 d. The median mRS was 1 (range 0-4) at 30 d and 1 (range 0-5) at 90 d. One patient required a blood transfusion after thrombectomy.ConclusionIn this large series of pediatric patients treated with endovascular thrombectomy, successful recanalization was accomplished via a variety of approaches with excellent clinical outcomes; further prospective longitudinal study is needed.Copyright © 2020 by the Congress of Neurological Surgeons.

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