Recanalization Treatments for Pediatric Acute Ischemic Stroke in France
Authors: Kossorotoff Manoëlle , Kerleroux Basile , Boulouis Grégoire , Husson Béatrice , Tran Dong Kim , Eugene François , Damaj Lena , Ozanne Augustin , Bellesme Céline , Rolland Anne , Bourcier Romain , Triquenot-Bagan Aude , Marnat Gaultier , Neau Jean-Philippe , Joriot Sylvie , Perez Alexandra , Guillen Maud , Perivier Maximilien , Audic Frederique , Hak Jean François , Denier Christian , Naggara Olivier ,   KidClot Group, BEN HASSEN WAGIH , KOSSOROTOFF MANOËLLE , NAGGARA OLIVIER , KERLEROUX BASILE , DENIER CHRISTIAN , OZANNE AUGUSTIN , BELLESME CÉLINE , HUSSON BÉATRICE , HUGUES CHABRIAT , PEGGY REINER , LAMY CATHERINE , CLARENÇON FREDERIC , DELTOUR SANDRINE , LEVASSEUR MICHÈLE , LUN FRANÇOIS , HOSSEINI HASSAN , VILLAIN ADRIEN , LAMY CHANTAL , HERY LOÏC , CHIVOT CYRIL , GUEDEN SOPHIE , BOUAMRA BENJAMIN , BELLEVILLE GOFFENEY JOANNA , BIONDI ALESSANDRA , RENOU PAULINE , THIBAUD MARIE , MARNAT GAULTIER , BACH NATHALIE , FERRIER ANNA , REMERAND GANAELLE , CHABERT EMMANUEL , BÉJOT YANNICK , DETANTE OLIVIER , LAMETERY ELODIE , TAHON FLORENCE , CORDONNIER CHARLOTTE , SYLVIE JORIOT , APOLLINE KAZEMI , LAROCHE CECILE , SALEME SUZANA , DEREX LAURENT , CARNEIRO MARYLINE , EKER OMER , AUDIC FREDERIQUE , DORY LAUTREC PHILIPPE , GIRARD NADINE , ARQUIZAN CAROLINE , MEYER PIERRE , RICHARD SEBASTIEN , BILBAULT CLAIRE , DESAL HUBERT , ROLLAND ANNE , ROMAIN BOURCIER , GONDON EMMANUELLE , SEDAT JACQUES , AUZOU PASCAL , OZSANCAK CANAN , CAMI GUILLAUME , NEAU JEAN PHILIPPE , RAYNAUD NICOLAS , VELASCO STÉPHANE , VANNIER STEPHANE , DAMAJ LÉNA , FERRÉ JEAN CHRISOPHE , EUGENE FRANCOIS , TRIQUENOT BAGAN AUDE , PAPAGIANNAKI CHRISANTHI , WOLFF VALÉRIE , PEREZ ALEXANDRA , BEAUJEUX RÉMY , CHEURET EMMANUEL , DARCOURT JEAN , JANOT KEVIN , PERIVIER MAXIMILIEN , HERBRETEAUX DENIS 
Published: September 2022

Importance

There is to date limited evidence that revascularization strategies are associated with improved functional outcome in children with acute ischemic stroke (AIS).

Objectives

To report clinical outcomes and provide estimates of revascularization strategy safety and efficacy profiles of intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) in children with AIS.

Design, Setting, and Participants

The KidClot multicenter nationwide cohort study retrospectively collected data of children (neonates excluded) with AIS and recanalization treatment between January 1, 2015, and May 31, 2018. Data analysis was performed from January 1, 2015, to May 31, 2019.

Exposure

IVT and/or EVT.

Main Outcomes and Measures

Primary outcome was day 90 favorable outcome (modified Rankin Scale [mRs] 0-2, with 0 indicating no symptoms and 6 indicating death). Secondary end points included 1-year favorable outcome (mRs, 0-2), mortality, and symptomatic intracerebral hemorrhage. Other measures included the Pediatric National Institutes of Health Stroke Scale (pedNIHSS), with pedNIHSS 0 indicating no symptoms, 1 to 4 corresponding to a minor stroke, 5 to 15 corresponding to a mild stroke, greater than 15 to 20: severe stroke, and the adult Alberta Stroke Program Early CT Score (ASPECTS), which provides segmental assessment of the vascular territory, with 1 point deducted from the initial score of 10 for every region involved (from 10 [no lesion] to 0 [maximum lesions]).

Results

Overall, 68 children were included in 30 centers (IVT [n = 44]; EVT [n = 40]; 44 boys [64.7%]; median [IQR] age, 11 [4-16] years; anterior circulation involvement, 57 [83.8%]). Median (IQR) pedNIHSS score at admission was 13 (7-19), higher in the EVT group at 16 (IQR, 10-20) vs 9 (6-17) in the IVT only group (P &lt; .01). Median time from stroke onset to imaging was higher in the EVT group at 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). Median admission ASPECTS score was 8 (IQR, 6-9). The main stroke etiologies were cardioembolic (21 [30.9%]) and focal cerebral arteriopathy (17 [25.0%]). Median (IQR) time from stroke onset to IVT was 3 hours and 30 minutes (IQR, 2 hours and 33 minutes to 4 hours and 28 minutes). In the EVT group, the rate of postprocedure successful reperfusion (≥modified Treatment in Cerebral Infarction 2b) was 80.0% (32 of 40). Persistent proximal arterial stenosis was more frequent in focal cerebral arteriopathy (P &lt; .01). Death occurred in 3 patients (4.4%). Median pedNIHSS reduction at 24 hours was 4 (IQR, 0-9) points. Intracerebral hemorrhage occurred in 4 patients and symptomatic intracerebral hemorrhage occurred in 1 patient, all in the EVT group. The median mRS was 2 (IQR, 0-3) at day 90 and 1 (IQR, 0-2) at 1 year, which was not significantly different between EVT and IVT only groups, although different in initial severity.

Conclusions and Relevance

The findings of this cohort study suggest that use of EVT and/or IVT is safe in children with AIS.