Regional Pediatric Acute Stroke Protocol

Abstract

Hyperacute recanalization treatment in pediatric stroke, relying on common protocols and adult/pediatric ward collaboration, is feasible. Larger systematic case collection is encouraged.

Recanalization Treatments for Pediatric Acute Ischemic Stroke in France

“…26 It is arguable that in the absence of robust evidence for the efficacy of these newer strategies, this proportion will not steadily increase, but our study aimed to provide data for both clinicians admitting children with suspected AIS and policy makers to inform future treatment recommendations. Yet, as moving forward, the community needs to address the question as to why revascularization strategies are proposed at such low rates in children, limiting both the opportunities to optimize systems of care locally 7 and the feasibility of a randomized evaluation of…”

“…History of varicella was found in 12.5% (6 of 48 patients with available data) and potentially embolic heart condition in 16.2% (11). Median pedNIHSS at admission was 13 (IQR, 7-19) and was higher in patients treated with EVT (16 [IQR,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) vs 9 [IQR, [6][7][8][9][10][11][12][13][14][15][16][17]; P = .004). Median time from stroke onset to imaging was 2 hours and 54 minutes (IQR, 2 hours to 4 hours and 49 minutes) and was longer in patients treated with EVT (3 hours and 7 minutes; IQR, 2 hours and 3 minutes to 6 hours and 24 minutes vs 2 hours and 39 minutes; IQR, 1 hour and 51 minutes to 4 hours and 13 minutes; P = .04).…”

“…Reports of intravenous thrombolysis (IVT) in children suggested a positive safety profile, despite the limited number of patients included. 7,8 The SaveChildS study 9 analyzed data from a multicenter cohort that included 73 children treated with EVT between 2000 and 2018. The investigators reported that EVT appeared to have a positive safety profile in children with large-vessel occlusion, similar to the results of the largest real-world prospective adult registries, and that long-term neurologic outcome was good in most patients.…”

“…However, the generalizability of results remains limited by many approximations regarding the population characteristics and outcomes owing to the lack of key variables, such as the National Institutes of Health Stroke Scale (NIHSS) score or modified Rankin Scale score. At times of profound modifications in AIS treatment paradigms, attempts at optimizing systems of care toward pediatric stroke-ready networks have shown interest, 7 and both technical advances and better understanding of underlying etiologies of pediatric stroke have positioned the issue of pediatric AIS acute revascularization in the limelight. In a national multicenter retrospective study of consecutive children with AIS treated with IVT (using r-tPA) and/or EVT we aimed to provide an up-to-date evaluation of revascularization strategies in the pediatric population.…”

Successful Utilization of Mechanical Thrombectomy in a Presentation of Pediatric Acute Ischemic Stroke

“…Guidelines regarding the management of acute ischemic stroke (AIS) in the pediatric population are described [ 1 – 3 ], but the guidelines do not yet take into account the mechanical recanalization procedures [ 4 ]. More frequently, cases that describe successful endovascular revascularization in pediatric AIS have begun to show up in the literature [ 5 – 9 ]. We present a case of a 14-year-old male with acute onset stroke who underwent successful mechanical clot removal by interventional radiology.…”