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

Autor:	Sporns PB; Institute of Clinical Radiology, University Hospital of Muenster, Muenster, Germany., Sträter R; Department of Pediatrics, University Hospital of Muenster, Muenster, Germany., Minnerup J; Department of Neurology, University Hospital of Muenster, Muenster, Germany., Wiendl H; Department of Neurology, University Hospital of Muenster, Muenster, Germany., Hanning U; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Chapot R; Department of Neuroradiology, Alfried-Krupp Hospital, Essen, Germany., Henkes H; Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany., Henkes E; Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany., Grams A; Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria., Dorn F; Department for Diagnostic and Interventional Neuroradiology, University of Munich, Campus Grosshadern, Munich, Germany., Nikoubashman O; Department of Neuroradiology, Aachen University, Aachen, Germany., Wiesmann M; Department of Neuroradiology, Aachen University, Aachen, Germany., Bier G; Institute of Clinical Radiology, University Hospital of Muenster, Muenster, Germany.; Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Tuebingen, Germany., Weber A; Department of Radiology and Neuroradiology, Bochum, Germany., Broocks G; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Fiehler J; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Brehm A; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany., Psychogios M; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany., Kaiser D; Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany., Yilmaz U; Department of Neuroradiology, Saarland University Hospital, Homburg, Germany., Morotti A; Department of Neurology and Neurorehabilitation, Mondino Foundation, Pavia, Italy., Marik W; Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria., Nolz R; Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria., Jensen-Kondering U; Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany., Schmitz B; Section of Neuroradiology, University of Ulm, Guenzburg, Germany., Schob S; Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany., Beuing O; Department of Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany., Götz F; Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany., Trenkler J; Department of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria., Turowski B; Institute of Neuroradiology, University Hospital Duesseldorf, Duesseldorf, Germany., Möhlenbruch M; Department of Neuroradiology at Heidelberg University Hospital, Heidelberg, Germany., Wendl C; Department of Radiology, University Hospital Regensburg, Regensburg, Germany., Schramm P; Department of Neuroradiology, University Hospital of Luebeck, Luebeck, Germany., Musolino P; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Lee S; Division of Child Neurology, Department of Neurology, Stanford University, Stanford, California., Schlamann M; Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany., Radbruch A; Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany., Rübsamen N; Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany., Karch A; Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany., Heindel W; Institute of Clinical Radiology, University Hospital of Muenster, Muenster, Germany., Wildgruber M; Institute of Clinical Radiology, University Hospital of Muenster, Muenster, Germany., Kemmling A; Department of Neurology, University Hospital of Muenster, Muenster, Germany.
Jazyk:	angličtina
Zdroj:	JAMA neurology [JAMA Neurol] 2020 Jan 01; Vol. 77 (1), pp. 25-34.
DOI:	10.1001/jamaneurol.2019.3403
Abstrakt:	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.
Databáze:	MEDLINE
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