Study finds thrombectomy safe for childhood stroke victims

A small-scale study out of Germany has concluded thrombectomy—an already proven treatment for large intracranial vessel occlusions in adults—is also safe in children.

Childhood stroke is rare, with an estimated incidence of two to eight cases per 100,000 children per year, but Peter B. Sporns, MD, MHBA, and his colleagues said it’s important to find viable solutions for treating the cases that do come up. Thrombectomy is an effective alternative to intravenous thrombolysis alone, and past studies have suggested the interventional procedure could improve neurological outcomes in stroke victims.

“Endovascular thrombectomy has emerged as the standard of care for adult patients with acute ischemic stroke due to large-vessel occlusion,” Sporns and co-authors wrote in the Journal of the American Heart Association Feb. 26. “The knowledge about efficacy and safety of mechanical recanalization in childhood stroke, however, is limited to small patient series and case reports.”

The authors performed their own retrospective analysis of 12 children who were treated with mechanical thrombectomy at one of three German tertiary-care stroke centers. They assessed interventional results and clinical outcomes with the Pediatric National Institutes of Health Stroke Scale 24 hours, seven days and three months after the procedure.

The angiographic outcomes for thrombectomy were good in all 12 patients, according to the study, and most patients experienced improved neurological outcomes after the intervention. Post-procedure, children saw a six-times higher modified Treatment in Cerebral Infarction Score and, by day seven, ranked 3.5 on the Pediatric National Institutes of Health Stroke Scale. At three months, their average modified Rankin Scale rating was 1.

“Altogether, our patients had no complications after thrombectomy other than transient periprocedural vasospasm, detected angiographically, which occurred in two patients,” Sporns et al. wrote. “In line with previous reports, the majority of patients in this study showed good outcomes angiographically and, most importantly, substantial neurological improvements after the invasive recanalization were observed with a modified Rankin scale of less than two in 92 percent.”

The authors emphasized physicians still need to practice caution when performing thrombectomy in childhood stroke, since the procedure has been extensively studied only in adult populations. In particular, they said interventionalists should pay attention to the high risk of vessel injury, dissection and thrombosis with thrombectomy, especially in cases with vasculitis.

“Our study adds to the growing evidence that mechanical thrombectomy can be effective and safe not only in adults but also in childhood stroke,” they wrote. “However, caution has to be applied because etiology in childhood stroke differs substantially from that in acute ischemic stroke in adults, with potentially major impact on procedure success and safety.”