Department of Neurosurgery, University of Utah School of Medicine, Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah.
Department of Neurosurgery, Baylor College of Medicine, Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas.
Neurosurgery. 2020 Dec 15;88(1):46-54. doi: 10.1093/neuros/nyaa312.
Endovascular thrombectomy is a promising treatment for acute ischemic stroke in children, but outcome and technical data in pediatric patients with large-vessel occlusions are lacking.
To assess technical and clinical outcomes of thrombectomy in pediatric patients.
We undertook a retrospective cohort study of pediatric patients who experienced acute ischemic stroke from April 2017 to April 2019 who had immediate, 30-, and 90-d follow-up. Patients were treated with endovascular thrombectomy at 5 US pediatric tertiary care facilities. We recorded initial and postprocedural modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b, initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and pediatric modified Rankin scale (mRS) score 0 to 2 at 90 d.
There were 23 thrombectomies in 21 patients (mean age 11.6 ± 4.9 yr, median 11.5, range 2.1-19; 52% female). A total of 19 (83%) thrombectomies resulted in mTICI grade ≥ 2b recanalization. The median PedNIHSS score was 13 on presentation (range 4-33) and 2 (range 0-26) at discharge (mean reduction 11.3 ± 6.1). A total of 14 (66%) patients had a mRS score of 0 to 2 at 30-d follow-up; 18/21 (86%) achieved that by 90 d. The median mRS was 1 (range 0-4) at 30 d and 1 (range 0-5) at 90 d. One patient required a blood transfusion after thrombectomy.
In this large series of pediatric patients treated with endovascular thrombectomy, successful recanalization was accomplished via a variety of approaches with excellent clinical outcomes; further prospective longitudinal study is needed.
血管内血栓切除术是治疗儿童急性缺血性脑卒中的一种很有前途的方法，但缺乏大血管闭塞的儿科患者的治疗效果和技术数据。
评估血栓切除术在儿科患者中的技术和临床效果。
我们对 2017 年 4 月至 2019 年 4 月期间在 5 家美国儿科三级保健机构接受急性缺血性脑卒中治疗的儿科患者进行了回顾性队列研究。患者接受了血管内血栓切除术治疗。我们记录了初始和术后改良脑梗死溶栓（mTICI）分级≥2b、初始和术后小儿国立卫生研究院卒中量表（PedNIHSS）评分以及 90d 时的小儿改良 Rankin 量表（mRS）评分 0 至 2。
21 例患者共行 23 次血栓切除术（平均年龄 11.6±4.9 岁，中位数 11.5，范围 2.1-19；52%为女性）。19 例（83%）血栓切除术达到 mTICI 分级≥2b 再通。入院时平均 PedNIHSS 评分为 13 分（范围 4-33），出院时为 2 分（范围 0-26）（平均降低 11.3±6.1）。21 例患者中，14 例（66%）在 30d 随访时 mRS 评分为 0-2 分；18 例（86%）在 90d 时达到该评分。30d 时的平均 mRS 为 1 分（范围 0-4），90d 时为 1 分（范围 0-5）。1 例患者在血栓切除术后需要输血。
在这项对接受血管内血栓切除术治疗的大量儿科患者的研究中，通过各种方法实现了成功的再通，取得了极好的临床效果；需要进一步进行前瞻性纵向研究。
