Clinical diffusion mismatch to select pediatric patients for embolectomy 6 to 24 hours after stroke: An analysis of the Save ChildS Study
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Clinical diffusion mismatch to select pediatric patients for embolectomy 6 to 24 hours after stroke: An analysis of the Save ChildS Study. / Sporns, Peter B; Psychogios, Marios-Nikos; Straeter, Ronald; Hanning, Uta; Minnerup, Jens; Chapot, René; Henkes, Hans; Henkes, Elina; Grams, Astrid; Dorn, Franziska; Nikoubashman, Omid; Wiesmann, Martin; Bier, Georg; Weber, Anushe; Broocks, Gabriel; Fiehler, Jens; Brehm, Alex; Kaiser, Daniel; Yilmaz, Umut; Morotti, Andrea; Marik, Wolfgang; Nolz, Richard; Jensen-Kondering, Ulf; Braun, Michael; Schob, Stefan; Beuing, Oliver; Goetz, Friedrich; Trenkler, Johannes; Turowski, Bernd; Möhlenbruch, Markus; Wendl, Christina; Schramm, Peter; Musolino, Patricia L; Lee, Sarah; Schlamann, Marc; Radbruch, Alexander; Karch, André; Rübsamen, Nicole; Wildgruber, Moritz; Kemmling, André; Save ChildS Pro Investigators.
in: NEUROLOGY, Jahrgang 96, Nr. 3, 19.01.2021, S. e343-e351.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Clinical diffusion mismatch to select pediatric patients for embolectomy 6 to 24 hours after stroke: An analysis of the Save ChildS Study
AU - Sporns, Peter B
AU - Psychogios, Marios-Nikos
AU - Straeter, Ronald
AU - Hanning, Uta
AU - Minnerup, Jens
AU - Chapot, René
AU - Henkes, Hans
AU - Henkes, Elina
AU - Grams, Astrid
AU - Dorn, Franziska
AU - Nikoubashman, Omid
AU - Wiesmann, Martin
AU - Bier, Georg
AU - Weber, Anushe
AU - Broocks, Gabriel
AU - Fiehler, Jens
AU - Brehm, Alex
AU - Kaiser, Daniel
AU - Yilmaz, Umut
AU - Morotti, Andrea
AU - Marik, Wolfgang
AU - Nolz, Richard
AU - Jensen-Kondering, Ulf
AU - Braun, Michael
AU - Schob, Stefan
AU - Beuing, Oliver
AU - Goetz, Friedrich
AU - Trenkler, Johannes
AU - Turowski, Bernd
AU - Möhlenbruch, Markus
AU - Wendl, Christina
AU - Schramm, Peter
AU - Musolino, Patricia L
AU - Lee, Sarah
AU - Schlamann, Marc
AU - Radbruch, Alexander
AU - Karch, André
AU - Rübsamen, Nicole
AU - Wildgruber, Moritz
AU - Kemmling, André
AU - Save ChildS Pro Investigators
N1 - © 2020 American Academy of Neurology.
PY - 2021/1/19
Y1 - 2021/1/19
N2 - OBJECTIVE: To determine whether thrombectomy is safe in children up to 24 hours after onset of symptoms when selected by mismatch between clinical deficit and infarct.METHODS: A secondary analysis of the Save ChildS Study (January 2000-December 2018) was performed, including all pediatric patients (<18 years) diagnosed with arterial ischemic stroke who underwent endovascular recanalization at 27 European and United States stroke centers. Patients were included if they had a relevant mismatch between clinical deficit and infarct.RESULTS: Twenty children with a median age of 10.5 (interquartile range [IQR] 7-14.6) years were included. Of those, 7 were male (35%), and median time from onset to thrombectomy was 9.8 (IQR 7.8-16.2) hours. Neurologic outcome improved from a median Pediatric NIH Stroke Scale score of 12.0 (IQR 8.8-20.3) at admission to 2.0 (IQR 1.2-6.8) at day 7. Median modified Rankin Scale (mRS) score was 1.0 (IQR 0-1.6) at 3 months and 0.0 (IQR 0-1.0) at 24 months. One patient developed transient peri-interventional vasospasm; no other complications were observed. A comparison of the mRS score to the mRS score in the DAWN and DEFUSE 3 trials revealed a higher proportion of good outcomes in the pediatric compared to the adult study population.CONCLUSIONS: Thrombectomy in pediatric ischemic stroke in an extended time window of up to 24 hours after onset of symptoms seems safe and neurologic outcomes are generally good if patients are selected by a mismatch between clinical deficit and infarct.CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for children with acute ischemic stroke with a mismatch between clinical deficit and infarct size, thrombectomy is safe.
AB - OBJECTIVE: To determine whether thrombectomy is safe in children up to 24 hours after onset of symptoms when selected by mismatch between clinical deficit and infarct.METHODS: A secondary analysis of the Save ChildS Study (January 2000-December 2018) was performed, including all pediatric patients (<18 years) diagnosed with arterial ischemic stroke who underwent endovascular recanalization at 27 European and United States stroke centers. Patients were included if they had a relevant mismatch between clinical deficit and infarct.RESULTS: Twenty children with a median age of 10.5 (interquartile range [IQR] 7-14.6) years were included. Of those, 7 were male (35%), and median time from onset to thrombectomy was 9.8 (IQR 7.8-16.2) hours. Neurologic outcome improved from a median Pediatric NIH Stroke Scale score of 12.0 (IQR 8.8-20.3) at admission to 2.0 (IQR 1.2-6.8) at day 7. Median modified Rankin Scale (mRS) score was 1.0 (IQR 0-1.6) at 3 months and 0.0 (IQR 0-1.0) at 24 months. One patient developed transient peri-interventional vasospasm; no other complications were observed. A comparison of the mRS score to the mRS score in the DAWN and DEFUSE 3 trials revealed a higher proportion of good outcomes in the pediatric compared to the adult study population.CONCLUSIONS: Thrombectomy in pediatric ischemic stroke in an extended time window of up to 24 hours after onset of symptoms seems safe and neurologic outcomes are generally good if patients are selected by a mismatch between clinical deficit and infarct.CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for children with acute ischemic stroke with a mismatch between clinical deficit and infarct size, thrombectomy is safe.
U2 - 10.1212/WNL.0000000000011107
DO - 10.1212/WNL.0000000000011107
M3 - SCORING: Journal article
C2 - 33144517
VL - 96
SP - e343-e351
JO - NEUROLOGY
JF - NEUROLOGY
SN - 0028-3878
IS - 3
ER -
