Department of Medical Imaging, Children's Hospital at Westmead, Westmead, Australia.
Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia.
JAMA Neurol. 2022 May 1;79(5):488-497. doi: 10.1001/jamaneurol.2022.0323.
The incidence and natural history of large vessel occlusion (LVO) stroke in children is largely unknown. These knowledge gaps limit the uptake of reperfusion therapies and reduce the efficiency of pediatric acute stroke pathways.
To determine the incidence and natural history of pediatric LVO stroke.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based cohort study was conducted between January 2010 and December 2019, with a mean (SD) follow-up of 37.0 (28.8) months. Admissions from all pediatric hospitals in the state of New South Wales, Australia, with a final diagnosis of arterial ischemic stroke (AIS) in patients 1 month to younger than 17 years were included. A total of 85 of 251 identified cases were excluded based on selection criteria. Data were analyzed from July 2020 to June 2021.
One-third of patients with LVO received mechanical thrombectomy with or without intravenous thrombolysis while the remainder were treated conservatively.
The primary outcome was the pediatric modified Rankin Scale (ped-mRS) score 3 months after stroke. Ordinal logistic regression was used to compare non-LVO, LVO without thrombectomy, and LVO with thrombectomy groups.
Of 161 included patients, 56 (34.8%) were female, and the mean (SD) age was 6.1 (5.4) years. A total of 166 AIS admissions were studied, and clinical follow-up was available for 164 of 166 admissions. LVO was present in 39 admissions (23.5%). The incidence of LVO stroke was 0.24 per 100 000 patients per year (95% CI, 0.13-0.35). Patients with LVO who did not receive thrombectomy (n = 26) had poor neurological outcomes, with 19 (73.1%) experiencing moderate to severe disability or death (ped-mRS score of 3 to 6) at 3 months (6 of 12 patients receiving thrombectomy [50.0%]; 25 of 38 patients with LVO [65.8%]). Patients with LVO without thrombectomy had significantly worse clinical outcomes than patients with non-LVO at 3 months (odds ratio, 3.64; 95% CI, 1.68-7.87; P = .001). Most patients with LVO presented within time windows suitable for thrombectomy (27 of 39 [69.2%] within 6 hours; 35 of 39 [89.7%] within 24 hours).
In this population-based cohort study, the natural history of pediatric patients with LVO stroke treated conservatively was poor, with most experiencing lifelong disability or death. Nearly 90% of pediatric patients with LVO presented within time windows suitable for thrombectomy.
儿童大血管闭塞（LVO）卒中的发病率和自然病史在很大程度上尚不清楚。这些知识空白限制了再灌注治疗的应用，并降低了儿科急性卒中通路的效率。
确定儿科 LVO 卒中的发病率和自然病史。
设计、设置和参与者：这是一项回顾性基于人群的队列研究，于 2010 年 1 月至 2019 年 12 月进行，平均（SD）随访 37.0（28.8）个月。纳入了来自澳大利亚新南威尔士州所有儿科医院的患者，这些患者在 1 个月至 16 岁以下时最终诊断为动脉缺血性卒中（AIS）。根据选择标准，共有 251 例中 85 例被排除。数据于 2020 年 7 月至 2021 年 6 月进行分析。
三分之一的 LVO 患者接受了机械血栓切除术联合或不联合静脉溶栓治疗，而其余患者则接受了保守治疗。
主要结局是卒中后 3 个月时的小儿改良 Rankin 量表（ped-mRS）评分。采用有序逻辑回归比较非 LVO、LVO 无血栓切除术和 LVO 有血栓切除术组。
在纳入的 161 例患者中，56 例（34.8%）为女性，平均（SD）年龄为 6.1（5.4）岁。共研究了 166 例 AIS 入院患者，166 例入院患者中有 164 例可获得临床随访。39 例（23.5%）存在 LVO。LVO 卒中的发病率为每年每 100000 名患者 0.24 例（95%CI，0.13-0.35）。未接受血栓切除术的 LVO 患者（n=26）神经功能预后较差，3 个月时 19 例（73.1%）出现中度至重度残疾或死亡（ped-mRS 评分 3-6）（12 例接受血栓切除术的患者中 6 例[50.0%]；38 例 LVO 患者中 25 例[65.8%]）。与非 LVO 患者相比，接受 LVO 无血栓切除术的患者在 3 个月时的临床结局明显较差（优势比，3.64；95%CI，1.68-7.87；P=0.001）。大多数 LVO 患者在适合血栓切除术的时间窗内就诊（39 例中的 27 例[69.2%]在 6 小时内；39 例中的 35 例[89.7%]在 24 小时内）。
在这项基于人群的队列研究中，接受保守治疗的儿科 LVO 卒中患者的自然病史较差，大多数患者终生残疾或死亡。近 90%的儿科 LVO 患者在适合血栓切除术的时间窗内就诊。
