Department of Pediatrics, Division of Child Neurology, University Children's Hospital Bern, University of Bern, Bern.
Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern.
Ann Neurol. 2018 Jun;83(6):1125-1132. doi: 10.1002/ana.25242.
Intravenous thrombolysis and endovascular therapy (IVT/EVT) are evidence-based treatments for adults with arterial ischemic stroke (AIS). However, randomized controlled trials in pediatric patients are lacking. This study aimed to describe feasibility, safety, and outcome of IVT/EVT in children with AIS.
This retrospective study (01/2000-12/2015) included a multicenter, population-based consecutive cohort of patients aged 1 month to 16 years, diagnosed with AIS and presenting with pediatric National Institutes of Health Stroke Scale (pedNIHSS) ≥ 4. Clinical and radiological data of patients receiving IVT/EVT were compared to those receiving standard care (SC) using linear regression to adjust for potential confounders. EVT included intra-arterial thrombolysis and/or mechanical thrombectomy. Outcome was assessed 6 months after stroke using the pediatric stroke outcome measure (PSOM).
Overall, 150 patients (age 7.1 ± 4.9 years, 55 [37%] females) presented with pedNIHSS ≥ 4. Recanalization treatment was performed in 16 (11%), of whom 5 (3%) were treated with IVT and 11 (7%) with EVT. Patients receiving recanalization treatment were older (mean age = 11.0 vs 6.9 years, p = 0.01) and more severely affected (median pedNIHSS = 13.5 vs 8.0, p < 0.001). Death and bleeding complications did not differ between the 2 groups. Median (interquartile range) PSOM 6 months after AIS was 2.5 (1-4.3) and 1 (0-2) in the IVT/EVT and SC groups, respectively (p = 0.014). However, after multiple linear regression analysis, only higher baseline pedNIHSS remained associated with an unfavorable outcome (p < 0.001).
Recanalization treatment is feasible and seems to be safe in severely affected pediatric AIS patients. The assessment of efficacy of IVT/EVT in pediatric stroke patients requires larger studies. Ann Neurol 2018;83:1125-1132.
静脉溶栓和血管内治疗（IVT/EVT）是治疗成人动脉缺血性脑卒中（AIS）的循证治疗方法。然而，儿科患者的随机对照试验却很缺乏。本研究旨在描述 AIS 患儿接受 IVT/EVT 的可行性、安全性和结局。
本回顾性研究（2000 年 1 月至 2015 年 12 月）纳入了多中心、基于人群的连续队列，研究对象为年龄在 1 个月至 16 岁、经诊断患有 AIS 且具有儿科国立卫生研究院卒中量表（pedNIHSS）评分≥4 分的患儿。采用线性回归对接受 IVT/EVT 与接受标准治疗（SC）的患儿的临床和影像学数据进行比较，以调整潜在的混杂因素。EVT 包括动脉内溶栓和/或机械血栓切除术。采用小儿卒中结局量表（PSOM）于卒中后 6 个月评估结局。
共有 150 例患儿（年龄 7.1±4.9 岁，55 例[37%]为女性）具有 pedNIHSS 评分≥4 分。16 例（11%）患儿接受了再通治疗，其中 5 例（3%）接受了 IVT，11 例（7%）接受了 EVT。接受再通治疗的患儿年龄更大（平均年龄 11.0 岁 vs 6.9 岁，p=0.01），且病情更严重（中位数 pedNIHSS 评分 13.5 分 vs 8.0 分，p<0.001）。两组患儿的死亡和出血并发症发生率无差异。AIS 后 6 个月，IVT/EVT 组和 SC 组的 PSOM 中位数（四分位距）分别为 2.5（1-4.3）和 1（0-2）分（p=0.014）。然而，经多元线性回归分析，仅较高的基线 pedNIHSS 与不良结局相关（p<0.001）。
严重 AIS 患儿接受再通治疗是可行的，且似乎安全。需要更大规模的研究来评估 IVT/EVT 在儿科卒中患儿中的疗效。
