Assistance publique-Hôpitaux de Paris, CHU Saint-Étienne, CH Sainte-Anne, French Center for Pediatric Stroke, France (S.C., A.O., O.N., G.B., B.H., M.K.).
Inserm, Université Saint-Étienne, UMR1059, Saint-Étienne, France (S.C.).
Stroke. 2021 Jan;52(1):381-384. doi: 10.1161/STROKEAHA.120.031133. Epub 2020 Dec 22.
No controlled pharmacological studies are available in the field of pediatric stroke, except for sickle cell disease. Therefore, while pharmacological and mechanical recanalization treatments have repeatedly shown clinical benefit in adults with arterial ischemic stroke, pediatric strokologists still cannot base their therapeutic management (including hyperacute strategies) on high-level evidence. Once again, pediatricians face the same dichotomic choice: adapting adult procedures now versus waiting-for a long time-for the corresponding pediatric trials. One way out is building a compromise based on observational studies with large, longitudinal, comprehensive, real-life, and multisource dataset. Two recent high-quality observational studies have delivered promising conclusions on recanalization treatments in pediatric arterial ischemic stroke. TIPSTER (Thrombolysis in Pediatric Stroke Extended Results) showed that the risk of severe intracranial hemorrhage after intravenous thrombolysis is low; the Save Childs Study reported encouraging data about pediatric thrombectomy. Beyond the conclusion of a satisfactory global safety profile, a thorough analysis of the methods, populations, results, and therapeutic complications of these studies helps us to refine indications/contraindications and highlights the safeguards we need to rely on when discussing thrombolysis and thrombectomy in children. In conclusion, pediatric strokologists should not refrain from using clot lysis/retrieval tools in selected children with arterial ischemic stroke. But the implementation of hyperacute care is only feasible if the right candidate is identified through the sharing of common adult/pediatric protocols and ward collaboration, formalized well before the child's arrival. These anticipated protocols should never undervalue contraindications from adult guidelines and must involve the necessary pediatric expertise when facing specific causes of stroke, such as focal cerebral arteriopathy of childhood.
除镰状细胞病外，儿科卒中领域尚无对照药理学研究。因此，虽然血管内再通治疗和机械取栓治疗在成人缺血性卒中中已多次显示出临床获益，但儿科卒中医生仍不能将其治疗管理（包括超急性期策略）建立在高级别证据基础上。儿科医生再次面临同样的二分法选择：现在采用成人方法，还是等待很长时间进行相应的儿科试验。一种方法是基于大型、纵向、全面、真实生活和多源数据集的观察性研究建立折衷方案。最近的两项高质量观察性研究对儿科急性缺血性卒中的再通治疗得出了有希望的结论。TIPSTER（儿童卒中溶栓扩展结果）研究表明，静脉溶栓后发生严重颅内出血的风险较低；Save Childs 研究报告了关于儿科取栓术的令人鼓舞的数据。除了满意的总体安全性概况的结论外，对这些研究的方法、人群、结果和治疗并发症进行深入分析，有助于我们细化适应证/禁忌证，并强调在讨论儿童溶栓和取栓时需要依靠的保障措施。总之，儿科卒中医生不应避免在有选择的急性缺血性卒中患儿中使用血栓溶解/回收工具。但只有通过共享通用的成人/儿科方案和病房协作，在患儿到达之前明确合适的候选者，才能实现超急性期治疗。这些预期方案决不能低估成人指南的禁忌证，并且在面临特定的卒中病因（如儿童局灶性脑动脉病）时，必须涉及必要的儿科专业知识。
