Tenecteplase in Acute Stroke: What About the Children?

Sun, Lisa R.; Wilson, Jenny; Waak, Michaela; Kiskaddon, Amy; Goldenberg, Neil A.; Jordan, Lori C.; Barry, M L Wolfe

doi:10.1161/strokeaha.123.042951

Cited by 5 publications

(2 citation statements)

References 26 publications

(30 reference statements)

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“…There has been a paucity of research on the safety and efficacy of well-established adult modalities in the treatment of pediatric stroke [8]. Emerging evidence suggests that both endovascular thrombectomy and tPA, such as tenecteplase, may be viable treatment options for pediatric patients [9,10]. However, further studies with larger numbers of participants are required before their use can be established…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke in a Teenage Patient: Are We “MIS-C”ing Something?

Moin,

Lowe,

Desai

2023

Cureus

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The reported annual incidence of acute ischemic stroke (AIS) among pediatric and young adults is 1-13/100,000. In adults, ischemic stroke is attributed to several risk factors such as smoking, hypertension, atherosclerosis, and diabetes. Alternatively, pediatric ischemic stroke is associated with a broad spectrum of etiologies including prematurity, congenital heart disease, arteriopathies like moyamoya, chronic inflammatory disease, sickle cell, hypercoagulability, and malignancy. In rare cases, AIS has been associated with multisystem inflammatory syndrome in children (MIS-C), a Kawasaki-like inflammatory disease affecting patients younger than 21 years of age. This recently recognized and rare condition has been linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and presentations can vary widely in terms of severity and systemic involvement. While the exact reason behind this association is unknown, there is a growing body of evidence in adult literature that links SARS-CoV-2 infection to hypercoagulability and immune-mediated thrombosis. In pediatric patients, this association is not very clear.We report a case of a 17-year-old, previously healthy male who presented with acute-onset expressive aphasia, right-sided hemiparesis, and facial droop after two weeks from experiencing coronavirus disease 2019 (COVID-19)-like symptoms. A non-contrast head CT revealed an acute left M2 territory infarct while serum workup was consistent with MIS-C. Providers must maintain a high degree of suspicion and consider AIS in pediatric patients presenting with even mild neurological changes and a recent history of SARS-CoV-2 infection.

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Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke in a Teenage Patient: Are We “MIS-C”ing Something?

Moin,

Lowe,

Desai

2023

Cureus

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“…16 With increased pediatric stroke awareness, further studies seem feasible, but the adult stroke community's ongoing transition to the thrombolytic tenecteplase is complex for those who treat children given that pediatric pharmacokinetic data and dosing guidance are lacking. 17 Simple extrapolation of adult care to children with stroke is a pitfall. Future work should include a focus on defining clinical and radiographic biomarkers to refine selection criteria for acute recanalization strategies including those used in adults (eg, collateral status, salvageable penumbra) but also those unique to children (eg, mechanism of stroke, young age).…”

Section: Recanalization Therapies For Acute Strokementioning

confidence: 99%

Stroke in Children: Key Advances in the Field and the Next 20 Years

Kirton,

Jordan

2024

Stroke

Self Cite

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Cerebral arteriopathy, a frequent cause of stroke in children, and its relation to infection have been an active area of research with 2 large observational studies completed (VIPS I and II). 11,12 Two multicenter clinical trials are in progress that aim to determine if high-dose methylprednisolone in children with focal cerebral arteriopathy can improve or stabilize disease and reduce arterial ischemic stroke recurrence (the PASTA trial [Pediatric Arteriopathy Steroid Aspirin] and the FOCAS trial [Focal Cerebral Arteriopathy Steroid]). 13,14 The genetics of more diverse arteriopathies are not well understood but rapid progress suggests these will be important targets in the coming decades.

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Stroke in sickle cell patients, epidemiology, pathophysiology, systemic and surgical treatment options and prevention strategies

Shah,

Alberts,

Ngo

et al. 2024

Clinical and Translational Dis

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BackgroundA hereditary haemoglobinopathy known as sickle cell disease (SCD) affects over 100 000 people in the United States severely. Cerebrovascular disease is a prominent consequence of SCD. By the age of 30, 53% of patients have silent cerebral infarcts (SCIs) (a stroke that occurs without any obvious symptoms because it damages a small part of the brain that isn't responsible for any essential functions), and by the age of 40, 3.8% have overt strokes.Main bodyThe multidimensional burden of cerebrovascular illness in SCD is reviewed in detail in this article, which includes both clinical strokes and the frequently asymptomatic SCIs. The intricate pathophysiology of SCD and stroke is explored. With SCD, there are currently very few methods for preventing primary and secondary stroke; the most common ones are hydroxyurea and blood transfusion. Nevertheless, not enough research has been done on the possible contributions of anticoagulation and aspirin to strokes linked to SCD. Promising evidence is also highlighted in the study, suggesting that new drugs intended to treat SCD may be able to alleviate leg ulcers and renal impairment in addition to reducing unusually high transcranial Doppler flow velocity – a crucial component of cerebrovascular events. Given that these novel medications specifically target haemolysis and vaso‐occlusion, the two main causes of strokes in this population, more research is desperately needed to determine whether they are effective in avoiding strokes in people with SCD. The literature review also emphasizes how common healthcare inequities are and how they hinder advancements in SCD research and management in the United States.ConclusionTo successfully address these inequities, the evaluation recommends more funding for both SCD management and research, as well as for patient and clinician education. This multimodal viewpoint highlights the intricate terrain of cerebrovascular problems associated with SCD and the urgent need for all‐encompassing and fair strategies to improve patient outcomes and advance research.

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Tenecteplase in Acute Stroke: What About the Children?

Cited by 5 publications

References 26 publications

Acute Ischemic Stroke in a Teenage Patient: Are We “MIS-C”ing Something?

Acute Ischemic Stroke in a Teenage Patient: Are We “MIS-C”ing Something?

Stroke in Children: Key Advances in the Field and the Next 20 Years

Stroke in sickle cell patients, epidemiology, pathophysiology, systemic and surgical treatment options and prevention strategies

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