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Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study

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Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study. / Sporns, Peter B; Sträter, Ronald; Minnerup, Jens; Wiendl, Heinz; Hanning, Uta; Chapot, René; Henkes, Hans; Henkes, Elina; Grams, Astrid; Dorn, Franziska; Nikoubashman, Omid; Wiesmann, Martin; Bier, Georg; Weber, Anushe; Broocks, Gabriel; Fiehler, Jens; Brehm, Alex; Psychogios, Marios; Kaiser, Daniel; Yilmaz, Umut; Morotti, Andrea; Marik, Wolfgang; Nolz, Richard; Jensen-Kondering, Ulf; Schmitz, Bernd; Schob, Stefan; Beuing, Oliver; Götz, Friedrich; Trenkler, Johannes; Turowski, Bernd; Möhlenbruch, Markus; Wendl, Christina; Schramm, Peter; Musolino, Patricia; Lee, Sarah; Schlamann, Marc; Radbruch, Alexander; Rübsamen, Nicole; Karch, André; Heindel, Walter; Wildgruber, Moritz; Kemmling, André.

In: JAMA NEUROL, Vol. 77, No. 1, 01.01.2020, p. 25-34.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Sporns, PB, Sträter, R, Minnerup, J, Wiendl, H, Hanning, U, Chapot, R, Henkes, H, Henkes, E, Grams, A, Dorn, F, Nikoubashman, O, Wiesmann, M, Bier, G, Weber, A, Broocks, G, Fiehler, J, Brehm, A, Psychogios, M, Kaiser, D, Yilmaz, U, Morotti, A, Marik, W, Nolz, R, Jensen-Kondering, U, Schmitz, B, Schob, S, Beuing, O, Götz, F, Trenkler, J, Turowski, B, Möhlenbruch, M, Wendl, C, Schramm, P, Musolino, P, Lee, S, Schlamann, M, Radbruch, A, Rübsamen, N, Karch, A, Heindel, W, Wildgruber, M & Kemmling, A 2020, 'Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study', JAMA NEUROL, vol. 77, no. 1, pp. 25-34. https://doi.org/10.1001/jamaneurol.2019.3403

APA

Sporns, P. B., Sträter, R., Minnerup, J., Wiendl, H., Hanning, U., Chapot, R., Henkes, H., Henkes, E., Grams, A., Dorn, F., Nikoubashman, O., Wiesmann, M., Bier, G., Weber, A., Broocks, G., Fiehler, J., Brehm, A., Psychogios, M., Kaiser, D., ... Kemmling, A. (2020). Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study. JAMA NEUROL, 77(1), 25-34. https://doi.org/10.1001/jamaneurol.2019.3403

Vancouver

Sporns PB, Sträter R, Minnerup J, Wiendl H, Hanning U, Chapot R et al. Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study. JAMA NEUROL. 2020 Jan 1;77(1):25-34. https://doi.org/10.1001/jamaneurol.2019.3403

Bibtex

@article{25f6db8b88654489aba55bb5a1e2f8d6,
title = "Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study",
abstract = "Importance: Randomized clinical trials have shown the efficacy of thrombectomy of large intracranial vessel occlusions in adults; however, any association of therapy with clinical outcomes in children is unknown.Objective: To evaluate the use of endovascular recanalization in pediatric patients with arterial ischemic stroke.Design, Setting, and Participants: This retrospective, multicenter cohort study, conducted from January 1, 2000, to December 31, 2018, analyzed the databases from 27 stroke centers in Europe and the United States. Included were all pediatric patients (<18 years) with ischemic stroke who underwent endovascular recanalization. Median follow-up time was 16 months.Exposures: Endovascular recanalization.Main Outcomes and Measures: The decrease of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score from admission to day 7 was the primary outcome (score range: 0 [no deficit] to 34 [maximum deficit]). Secondary clinical outcomes included the modified Rankin scale (mRS) (score range: 0 [no deficit] to 6 [death]) at 6 and 24 months and rate of complications.Results: Seventy-three children from 27 participating stroke centers were included. Median age was 11.3 years (interquartile range [IQR], 7.0-15.0); 37 patients (51%) were boys, and 36 patients (49%) were girls. Sixty-three children (86%) received treatment for anterior circulation occlusion and 10 patients (14%) received treatment for posterior circulation occlusion; 16 patients (22%) received concomitant intravenous thrombolysis. Neurologic outcome improved from a median PedNIHSS score of 14.0 (IQR, 9.2-20.0) at admission to 4.0 (IQR, 2.0-7.3) at day 7. Median mRS score was 1.0 (IQR, 0-1.6) at 6 months and 1.0 (IQR, 0-1.0) at 24 months. One patient (1%) developed a postinterventional bleeding complication and 4 patients (5%) developed transient peri-interventional vasospasm. The proportion of symptomatic intracerebral hemorrhage events in the HERMES meta-analysis of trials with adults was 2.79 (95% CI, 0.42-6.66) and in Save ChildS was 1.37 (95% CI, 0.03-7.40).Conclusions and Relevance: The results of this study suggest that the safety profile of thrombectomy in childhood stroke does not differ from the safety profile in randomized clinical trials for adults; most of the treated children had favorable neurologic outcomes. This study may support clinicians' practice of off-label thrombectomy in childhood stroke in the absence of high-level evidence.",
author = "Sporns, {Peter B} and Ronald Str{\"a}ter and Jens Minnerup and Heinz Wiendl and Uta Hanning and Ren{\'e} Chapot and Hans Henkes and Elina Henkes and Astrid Grams and Franziska Dorn and Omid Nikoubashman and Martin Wiesmann and Georg Bier and Anushe Weber and Gabriel Broocks and Jens Fiehler and Alex Brehm and Marios Psychogios and Daniel Kaiser and Umut Yilmaz and Andrea Morotti and Wolfgang Marik and Richard Nolz and Ulf Jensen-Kondering and Bernd Schmitz and Stefan Schob and Oliver Beuing and Friedrich G{\"o}tz and Johannes Trenkler and Bernd Turowski and Markus M{\"o}hlenbruch and Christina Wendl and Peter Schramm and Patricia Musolino and Sarah Lee and Marc Schlamann and Alexander Radbruch and Nicole R{\"u}bsamen and Andr{\'e} Karch and Walter Heindel and Moritz Wildgruber and Andr{\'e} Kemmling",
year = "2020",
month = jan,
day = "1",
doi = "10.1001/jamaneurol.2019.3403",
language = "English",
volume = "77",
pages = "25--34",
journal = "JAMA NEUROL",
issn = "2168-6149",
publisher = "American Medical Association",
number = "1",

}

RIS

TY - JOUR

T1 - Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study

AU - Sporns, Peter B

AU - Sträter, Ronald

AU - Minnerup, Jens

AU - Wiendl, Heinz

AU - Hanning, Uta

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 - Psychogios, Marios

AU - Kaiser, Daniel

AU - Yilmaz, Umut

AU - Morotti, Andrea

AU - Marik, Wolfgang

AU - Nolz, Richard

AU - Jensen-Kondering, Ulf

AU - Schmitz, Bernd

AU - Schob, Stefan

AU - Beuing, Oliver

AU - Götz, Friedrich

AU - Trenkler, Johannes

AU - Turowski, Bernd

AU - Möhlenbruch, Markus

AU - Wendl, Christina

AU - Schramm, Peter

AU - Musolino, Patricia

AU - Lee, Sarah

AU - Schlamann, Marc

AU - Radbruch, Alexander

AU - Rübsamen, Nicole

AU - Karch, André

AU - Heindel, Walter

AU - Wildgruber, Moritz

AU - Kemmling, André

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Importance: Randomized clinical trials have shown the efficacy of thrombectomy of large intracranial vessel occlusions in adults; however, any association of therapy with clinical outcomes in children is unknown.Objective: To evaluate the use of endovascular recanalization in pediatric patients with arterial ischemic stroke.Design, Setting, and Participants: This retrospective, multicenter cohort study, conducted from January 1, 2000, to December 31, 2018, analyzed the databases from 27 stroke centers in Europe and the United States. Included were all pediatric patients (<18 years) with ischemic stroke who underwent endovascular recanalization. Median follow-up time was 16 months.Exposures: Endovascular recanalization.Main Outcomes and Measures: The decrease of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score from admission to day 7 was the primary outcome (score range: 0 [no deficit] to 34 [maximum deficit]). Secondary clinical outcomes included the modified Rankin scale (mRS) (score range: 0 [no deficit] to 6 [death]) at 6 and 24 months and rate of complications.Results: Seventy-three children from 27 participating stroke centers were included. Median age was 11.3 years (interquartile range [IQR], 7.0-15.0); 37 patients (51%) were boys, and 36 patients (49%) were girls. Sixty-three children (86%) received treatment for anterior circulation occlusion and 10 patients (14%) received treatment for posterior circulation occlusion; 16 patients (22%) received concomitant intravenous thrombolysis. Neurologic outcome improved from a median PedNIHSS score of 14.0 (IQR, 9.2-20.0) at admission to 4.0 (IQR, 2.0-7.3) at day 7. Median mRS score was 1.0 (IQR, 0-1.6) at 6 months and 1.0 (IQR, 0-1.0) at 24 months. One patient (1%) developed a postinterventional bleeding complication and 4 patients (5%) developed transient peri-interventional vasospasm. The proportion of symptomatic intracerebral hemorrhage events in the HERMES meta-analysis of trials with adults was 2.79 (95% CI, 0.42-6.66) and in Save ChildS was 1.37 (95% CI, 0.03-7.40).Conclusions and Relevance: The results of this study suggest that the safety profile of thrombectomy in childhood stroke does not differ from the safety profile in randomized clinical trials for adults; most of the treated children had favorable neurologic outcomes. This study may support clinicians' practice of off-label thrombectomy in childhood stroke in the absence of high-level evidence.

AB - Importance: Randomized clinical trials have shown the efficacy of thrombectomy of large intracranial vessel occlusions in adults; however, any association of therapy with clinical outcomes in children is unknown.Objective: To evaluate the use of endovascular recanalization in pediatric patients with arterial ischemic stroke.Design, Setting, and Participants: This retrospective, multicenter cohort study, conducted from January 1, 2000, to December 31, 2018, analyzed the databases from 27 stroke centers in Europe and the United States. Included were all pediatric patients (<18 years) with ischemic stroke who underwent endovascular recanalization. Median follow-up time was 16 months.Exposures: Endovascular recanalization.Main Outcomes and Measures: The decrease of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score from admission to day 7 was the primary outcome (score range: 0 [no deficit] to 34 [maximum deficit]). Secondary clinical outcomes included the modified Rankin scale (mRS) (score range: 0 [no deficit] to 6 [death]) at 6 and 24 months and rate of complications.Results: Seventy-three children from 27 participating stroke centers were included. Median age was 11.3 years (interquartile range [IQR], 7.0-15.0); 37 patients (51%) were boys, and 36 patients (49%) were girls. Sixty-three children (86%) received treatment for anterior circulation occlusion and 10 patients (14%) received treatment for posterior circulation occlusion; 16 patients (22%) received concomitant intravenous thrombolysis. Neurologic outcome improved from a median PedNIHSS score of 14.0 (IQR, 9.2-20.0) at admission to 4.0 (IQR, 2.0-7.3) at day 7. Median mRS score was 1.0 (IQR, 0-1.6) at 6 months and 1.0 (IQR, 0-1.0) at 24 months. One patient (1%) developed a postinterventional bleeding complication and 4 patients (5%) developed transient peri-interventional vasospasm. The proportion of symptomatic intracerebral hemorrhage events in the HERMES meta-analysis of trials with adults was 2.79 (95% CI, 0.42-6.66) and in Save ChildS was 1.37 (95% CI, 0.03-7.40).Conclusions and Relevance: The results of this study suggest that the safety profile of thrombectomy in childhood stroke does not differ from the safety profile in randomized clinical trials for adults; most of the treated children had favorable neurologic outcomes. This study may support clinicians' practice of off-label thrombectomy in childhood stroke in the absence of high-level evidence.

U2 - 10.1001/jamaneurol.2019.3403

DO - 10.1001/jamaneurol.2019.3403

M3 - SCORING: Journal article

C2 - 31609380

VL - 77

SP - 25

EP - 34

JO - JAMA NEUROL

JF - JAMA NEUROL

SN - 2168-6149

IS - 1

ER -