Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Faculty of Medicine, October 6 University, 6th of October City, Egypt.
Clin Neuroradiol. 2023 Sep;33(3):635-644. doi: 10.1007/s00062-022-01246-y. Epub 2023 Jan 2.
Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke.
To investigate the efficacy and safety of MT in pediatric LVO.
A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). A fixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI).
In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77-95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09-61.62%) of the cases. The favorable (mRS = 0-2) and excellent (mRS = 0-1) outcome rates were 83.3% (95% CI = 73.54-94.50%) and 59.5% (95% CI = 44.24-80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0-3.30%) and mortality rate was 3.2% (95% CI = 0.55-7.38%).
In our meta-analysis, MT demonstrated a promising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as a first-line treatment strategy.
急性颅内大血管闭塞（LVO）是儿童发病率和死亡率的重要原因；然而，与成人不同，没有临床试验研究机械取栓（MT）在儿科 LVO 中的益处。因此，MT 仍然是儿科卒中的超适应证方法。
探讨 MT 在儿科 LVO 中的疗效和安全性。
在 Ovid MEDLINE、Ovid Embase、Scopus、Web of Science 和 Cochrane 临床试验中心注册数据库中进行了系统文献检索。纳入报告血管内治疗儿科 LVO 安全性和疗效结果的研究。从纳入的研究中提取再通、功能结局、症状性颅内出血（sICH）和死亡率的数据。功能结局采用改良 Rankin 量表（mRS）评估。采用固定或随机效应模型计算汇总事件发生率和 95%置信区间（CI）。
本研究纳入了 11 项研究，共 215 例患者。再通成功率为 90.3%（95%CI=85.77-95.11%），完全再通率为 52.7%（95%CI=45.09-61.62%）。良好（mRS=0-2）和优秀（mRS=0-1）结局率分别为 83.3%（95%CI=73.54-94.50%）和 59.5%（95%CI=44.24-80.06%）。总体 sICH 发生率为 0.59%（95%CI=0-3.30%），死亡率为 3.2%（95%CI=0.55-7.38%）。
在我们的荟萃分析中，MT 为儿科患者展示了有前途的安全性和疗效特征，具有一致的高疗效和低并发症发生率。我们的结果支持在儿科 LVO 中使用 MT；然而，仍需要前瞻性研究进一步确定儿科 MT 作为一线治疗策略的作用。
