Abstract WMP115: Thrombolysis and Thrombectomy in Pediatric Ischemic Stroke

Abstract

Introduction: Stroke is a devastating disease at any age. There are few studies on utility of intravenous thrombolysis (tPA) or intra-arterial thrombectomy (IAT) in pediatric acute ischemic stroke (AIS). Hypothesis: To describe and compare clinical outcomes of pediatric AIS patients who did and did not receive tPA+/-IAT. Methods: We retrospectively reviewed all pediatric AIS cases, aged 0-17, from the 2006-2010 Nationwide Inpatient Survey, a 20% stratified sample of all U.S. community hospitals. Demographics, outcomes, cost of stay, and comorbidities were assessed. Results: Overall, 20,587 patients were analyzed. Mean age was 6.0 years (SD 13.9); female 43.9%; white 47.7%. Of those, 198 patients received intervention: 169 tPA, 5 IAT, and 24 tPA+IAT. Treated patients were older (10.0 years vs 5.9 years, p<0.0001). Mortality for pediatric AIS patients was 7.8%; 13.8% in tPA patients compared to 7.7% in the untreated. No deaths in the IAT group. Non-treated patients were more likely to be discharged home than those receiving tPA+/-IAT (67.8% vs. 47.5%, p<0.0001). Cost for treated patients was higher ($200,346 vs. $123,015, p=0.01). Intracerebral hemorrhage (ICH) was more common in treated patients (10.1% vs. 3.8%, p<0.0001). Comorbidities included Moyamoya disease (12.4%), cardiac valvular disease (6.6%), and sickle cell disease (6.5%). The treated group had higher prevalence of pneumonia/influenza (17.2% vs. 7.6%, p<0.0001), procoagulable conditions (15.2% vs. 2%, p<0.0001), and cardiac valvular disease (15.2% vs. 6.5%, p<0.0001). Conclusions: In the pediatric AIS population, tPA was associated with increased mortality. Treatment with tPA+/-IAT was associated with decreased discharge home, increased cost, and higher prevalence of ICH. Prevalence of ICH is not explained by the presence of Moyamoya or sickle cell as those patients were less likely to receive treatment. Limitations of this study include small numbers of treated patients, lack of data on stroke severity or functional outcome, and data from years prior to newer thrombectomy devices. Studies of AIS treatment in adults cannot necessicarily be extrapolated given the difference in etiologies of pediatric AIS. Pediatric AIS is on the rise, so more research for effective treatment is necessary.