Thrombectomy safe for paediatric stroke patients

In the treatment of children with acute ischaemic stroke, endovascular thrombectomy (EVT) is safe and results in high rates of achieving favourable functional outcomes, as shown in a study.

Researchers used weighted discharge data from the National Inpatient Sample and identified 7,365 paediatric patients with ischaemic stroke, among whom 190 (2.6 percent) were treated with EVT during the period of 2010–2019. They applied complex sampling to characterize the profiles and clinical outcomes of EVT-treated patients.

Uptake of EVT significantly increased in the post-EVT clinical trial era (2016–2019; from 1.7 percent to 4.0 percent; p<0.001), while the use of decompressive hemicraniectomy decreased (from 2.8 percent vs 0.7 percent; p<0.001).

Unadjusted analysis showed that more than half of EVT-treated children (n=105, 55.3 percent) achieved favourable functional outcomes at discharge (home or to acute rehabilitation), without any periprocedural iatrogenic complications or instances of contrast-induced kidney injury being reported.

Next, the researchers performed propensity adjustment to address confounding by indication for EVT based on disparities in baseline characteristics between EVT-treated patients and those medically managed.

More EVT-treated patients achieved favourable functional outcomes compared with medically managed patients (55.3 percent vs 52.8 percent; p=0.830; adjusted hazard ratio for unfavourable outcome, 1.01, 95 percent CI, 0.51–2.03; p=0.972).

Among patients with baseline National Institutes of Health Stroke Scale score >11 (75th percentile of scores in cohort), EVT treatment consistently trended toward higher rates of favourable functional outcomes compared with medical treatment only (71.4 percent vs 55.6 percent; p=0.146).

In a subcohort assessment of EVT-treated patients, performing EVT prior to administering thrombolytic therapy was also associated with borderline significant higher rates of favourable functional outcomes (63.3 percent vs 49.5 percent; p=0.060).