School of Medicine Publications and Presentations
Document Type
Article
Publication Date
12-2024
Abstract
Background
Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.
Methods
In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960.
Findings
Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6–14]), and 91 patients received best medical treatment (6 years [3–12]; pvs2 [1–4]; p=0·074).
Interpretation
Clinical centres tended to select children with more severe strokes (higher PedNIHSS score) for endovascular thrombectomy. Nevertheless, endovascular thrombectomy was associated with improved functional outcomes in paediatric patients with large-vessel or medium-vessel occlusions compared with best medical treatment. Future studies need to investigate whether the positive effect of endovascular thrombectomy is confined to older and more severely affected children.
Recommended Citation
Sporns, P. B., Bhatia, K., Abruzzo, T., Pabst, L., Fraser, S., Chung, M. G., Lo, W., Othman, A., Steinmetz, S., Jensen-Kondering, U., Schob, S., Kaiser, D. P. O., Marik, W., Wendl, C., Kleffner, I., Henkes, H., Kraehling, H., Nguyen-Kim, T. D. L., Chapot, R., Yilmaz, U., … Wildgruber, M. (2024). Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study. The Lancet. Child & adolescent health, S2352-4642(24)00233-5. Advance online publication. https://doi.org/10.1016/S2352-4642(24)00233-5
Publication Title
The Lancet
DOI
https://doi.org/10.1016/S2352-4642(24)00233-5
Academic Level
faculty
Mentor/PI Department
Neurology
Comments
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.