Recanalization treatment for pediatric acute ischemic stroke: a nationwide french registry

Abstract

There's to date no solid evidence that revascularization strategies improve functional outcome in children. In this study of consecutive children with AIS stroke patients treated with intravenous thrombolysis (IVT) and, or endovascular treatment (EVT) we aimed to provide up to date estimates of revascularization strategies’ safety and efficacy profiles in the pediatric population. The French KIDCLOT multicentric nationwide retrospective study (NCT03887143) collected data of consecutive children aged >28 days and <18 years old with acute ischemic stroke who had a recanalization treatment between January 1rst 2015 and May 31rst 2018. Overall, 68children from 30 participating centers were analyzed including 24 girls (35.3%), with a mean age at stroke onset of 10.1 ± 5.7 years old. IVT was administered in 44 patients (64.7%) and EVT was performed in 40 children (58.8%). Mean pedNIHSS at admission was 13.1 ± 6.1 overall and was higher in patients treated with MT (15.6 ± 6.2 vs 10.6 ± 6, p<0.01). Mean time from stroke onset to imaging was higher in patients treated with MT (286.5 ± 244.2 vs 189 ± 97.6, p=0.03). AIS was due to an anterior circulation occlusion in 57 children (83.8%). Median [IQR] admission ASPECTS score was 8 [7–9] and did not differ significantly between patients treated with or without MT. Main stroke etiologies were cardio-embolic (30.9%), focal cerebral arteriopathy (FCA, 25%). Mean time from onset to IVT was 201.7 ± 73 overall and was higher in patients treated with MT (231,8±52,6 vs 174,6±76,2 p=0,02). In MT patients, the rate of successful reperfusion (≥mTICI 2b) was 80% (32/40). Persistent proximal arterial stenosis on final DSA images was significantly more frequent in FCA cases (p<0,01). Death was observed in 3 patients (4.4%), all within the first week. Mean pedNIHSS improvement at 24 hours was 4.2 ± 6.9 overall, slightly but not significantly better in the MT group (5.1 ± 7 vs 3.4 ± 6.9 p=0.34). In the MT group, one patient suffered of intracranial arterial perforation, and one other of embol in a new territory. ICH and SICH were observed in four and one patients respectively, all in the MT group. The median mRS score at 3 months was 2 (IQR, 0-3) and further improved to 1 (IQR, 0-2) after 12 months, not different between MT and no-MT group. This study provides encouraging safety data in a population of AIS children treated with either IVT, EVT or both. One-year neurological outcome was good in three quarter of the study sample. EVT is feasible with rates of successful revascularization and procedural duration of similar magnitude to those found in adult populations (references 1 to 5)