TOPLINE:

Endovascular thrombectomy (EVT) for children with acute ischemic stroke due to isolated occlusion of the M2 segment of the middle cerebral artery was linked to better functional outcomes and greater neurologic improvement than best medical therapy alone, a new cohort study showed.

METHODOLOGY:

• Analysis of registry data pooled from four published multicenter pediatric stroke studies included 40 children aged 28 days to 17 years with acute ischemic stroke due to isolated M2 occlusions. All presented within 24 hours since they were last seen well.
• Half of the participants were treated with EVT (median age, 12 years; 60% boys), and the other half with best medical therapy (median age, 10 years; 50% boys).
• The primary outcome was functional outcome on the pediatric modified Rankin Scale (ped-mRS) at 3-6 months.
• Secondary outcomes included neurologic improvement as measured on the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) from admission to 7 days, Pediatric Stroke Outcome Measure (PSOM) scores at discharge and at 3-6 months, ped-mRS score at 24 months, and the rate of successful recanalization (mTICI of 2b or better) in the EVT group. Safety outcomes included symptomatic intracranial hemorrhage (ICH), access-site complications, and the rate of intraprocedural vasospasm in the EVT group.

TAKEAWAY:

• Children treated with EVT showed significantly better functional outcomes at 3-6 months than those treated with medical therapy (median ped-mRS score, 1 vs 2, respectively; P = .015), with the benefits persisting at 24 months (P = .01).

• EVT vs medical therapy was associated with greater neurologic improvements from admission to day 7 on the PedNIHSS (score reduction, -9 vs -1; P < .001) and lower PSOM scores at 3-6 months (0.5 vs 2.5; P = .009) and at discharge (1 vs 3; P = .03).

  Successful recanalization was also achieved in 95% of the EVT group.

• Safety outcomes were favorable and similar between the groups, with no deaths or access-site complications reported. There was one symptomatic ICH in the medical therapy group, and transient intraprocedural vasospasm occurred in three members of the EVT group.
• Propensity score matching analysis (n = 14 in each group) confirmed that EVT was associated with better functional outcomes at 3-6 months and at 24 months than medical therapy (median ped-mRS scores, 1 vs 3; P = .03 for both periods), as well as better PSOM scores at 3-6 months (median, 0.5 vs 2.5; P = .01) and greater early neurologic improvement (median PedNIHSS score reduction, -8 vs 0; P = .01).

IN PRACTICE:

“EVT should be considered in carefully selected pediatric patients with M2 occlusion,” the investigators wrote.

“Further prospective data and international consensus are needed to guide standardized practice,” they added.

SOURCE:

The study was led by Peter B. Sporns, MD, Stadtspital Zürich, Zürich, Switzerland. It was published online on November 28 in Annals of Neurology.

LIMITATIONS:

The study was limited by its retrospective, nonrandomized design and small sample size, with unmeasured confounders potentially affecting outcomes. Imaging protocols were heterogeneous, and occlusion location and Alberta Stroke Program Early CT Scores were not centrally adjudicated. The cohorts were also heterogeneous, potentially limiting the generalizability of the findings.

DISCLOSURES:

The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.