• Peter B Sporns, Ronald Straeter, Jens Minnerup, Heinz Wiendl, Uta Hanning, René Chapot, Hans Henkes, Elina Henkes, Astrid Grams, Franziska Dorn, Omid Nikoubashman, Martin Wiesmann, Georg Bier, Anushe Weber, Gabriel Broocks, Jens Fiehler, Alex Brehm, Marios Psychogios, Daniel Kaiser, Umut Yilmaz, Andrea Morotti, Wolfgang Marik, Richard Nolz, Ulf Jensen-Kondering, Bernd Schmitz, Stefan Schob, Oliver Beuing, Friedrich Goetz, Johannes Trenkler, Bernd Turowski, Markus Möhlenbruch, Christina Wendl, Peter Schramm, Patricia Musolino, Sarah Lee, Marc Schlamann, Alexander Radbruch, Nicole Rübsamen, André Karch, Walter Heindel, Moritz Wildgruber, André Kemmling, and Save ChildS Investigators.
• From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany.
• Stroke. 2020 Apr 1; 51 (4): 1182-1189.

AbstractBackground 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. Registration- URL: https://www.drks.de/; Unique identifier: DRKS00016528.

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