From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N) and Department of Neurology (C.L.), INSERM UMR-S894, Université Paris-Descartes, Sainte-Anne Hospital, France.
Stroke. 2017 Aug;48(8):2278-2281. doi: 10.1161/STROKEAHA.117.016591. Epub 2017 May 25.
To evaluate hyperacute management of pediatric arterial ischemic stroke, setting up dedicated management pathways is the first recommended step to prove the feasibility and safety of such treatments. A regional pediatric stroke alert protocol including 2 centers in the Paris-Ile-de-France area, France, was established.
Consecutive pediatric patients (28 days-18 years) with confirmed arterial ischemic stroke who had acute recanalization treatment (intravenous r-tPA [recombinant tissue-type plasminogen activator], endovascular procedure, or both) according to the regional pediatric stroke alert were retrospectively reviewed during a 40-month period.
Thirteen children, aged 3.7 to 16.6 years, had recanalization treatment. Median time from onset to magnetic resonance imaging was 165 minutes (150-300); 9 out of 13 had large-vessel occlusion. Intravenous r-tPA was used in 11 out of 13 patients, with median time from onset to treatment of 240 minutes (178-270). Endovascular procedure was performed in patients time-out for intravenous r-tPA (n=2) or after intravenous r-tPA inefficiency (n=2). No intracranial or peripheral bleeding was reported. One patient died of malignant stroke; outcome was favorable in 11 out of 12 survivors (modified Rankin Scale score 0-2).
Hyperacute recanalization treatment in pediatric stroke, relying on common protocols and adult/pediatric ward collaboration, is feasible. Larger systematic case collection is encouraged.
评估儿科急性缺血性脑卒中的超急性期管理，建立专门的管理流程是证明此类治疗可行性和安全性的首要推荐步骤。法国巴黎大区的 2 个中心建立了一项包含儿科卒中预警的区域性儿科卒中预警协议。
回顾性分析了在 40 个月期间，根据区域性儿科卒中预警接受急性再通治疗（静脉注射重组组织型纤溶酶原激活剂[r-tPA]、血管内治疗或两者联合）的确诊为急性缺血性脑卒中的连续儿科患者（28 天至 18 岁）。
13 名年龄 3.7 至 16.6 岁的儿童接受了再通治疗。从发病到磁共振成像的中位时间为 165 分钟（150-300）；13 例中有 9 例存在大血管闭塞。11 例患者使用了静脉注射 r-tPA，从发病到治疗的中位时间为 240 分钟（178-270）。对于静脉注射 r-tPA 时间窗内的患者（n=2）或静脉注射 r-tPA 无效的患者（n=2），进行了血管内治疗。未报告颅内或外周出血。1 例患者因恶性脑卒中死亡；12 例存活患者中 11 例预后良好（改良Rankin 量表评分 0-2）。
依靠通用方案和成人/儿科病房合作，在儿科脑卒中进行超急性期再通治疗是可行的。鼓励进行更大规模的系统病例收集。
