Recanalization Treatments for Pediatric Acute Ischemic Stroke in France

• Published in: JAMA network open 2022-09, Vol.5 (9), p.e2231343-e2231343
• Main Authors: Kossorotoff, Manoëlle, Kerleroux, Basile, Boulouis, Grégoire, Husson, Béatrice, Tran Dong, Kim, Eugene, François, Damaj, Lena, Ozanne, Augustin, Bellesme, Céline, Rolland, Anne, Bourcier, Romain, Triquenot-Bagan, Aude, Marnat, Gaultier, Neau, Jean-Philippe, Joriot, Sylvie, Perez, Alexandra, Guillen, Maud, Perivier, Maximilien, Audic, Frederique, Hak, Jean François, Denier, Christian, Naggara, Olivier, BEN HASSEN, WAGIH, KOSSOROTOFF, MANOËLLE, NAGGARA, OLIVIER, KERLEROUX, BASILE, DENIER, CHRISTIAN, OZANNE, AUGUSTIN, BELLESME, CÉLINE, HUSSON, BÉATRICE, HUGUES, CHABRIAT, PEGGY, REINER, LAMY, CATHERINE, CLARENÇON, FREDERIC, DELTOUR, SANDRINE, LEVASSEUR, MICHÈLE, LUN, FRANÇOIS, HOSSEINI, HASSAN, VILLAIN, ADRIEN, LAMY, CHANTAL, HERY, LOÏC, CHIVOT, CYRIL, GUEDEN, SOPHIE, BOUAMRA, BENJAMIN, BELLEVILLE GOFFENEY, JOANNA, BIONDI, ALESSANDRA, RENOU, PAULINE, THIBAUD, MARIE, MARNAT, GAULTIER, BACH, NATHALIE, FERRIER, ANNA, REMERAND, GANAELLE, CHABERT, EMMANUEL, BÉJOT, YANNICK, DETANTE, OLIVIER, LAMETERY, ELODIE, TAHON, FLORENCE, CORDONNIER, CHARLOTTE, SYLVIE, JORIOT, APOLLINE, KAZEMI, LAROCHE, CECILE, SALEME, SUZANA, DEREX, LAURENT, CARNEIRO, MARYLINE, EKER, OMER, AUDIC, FREDERIQUE, DORY LAUTREC, PHILIPPE, GIRARD, NADINE, ARQUIZAN, CAROLINE, MEYER, PIERRE, RICHARD, SEBASTIEN, BILBAULT, CLAIRE, DESAL, HUBERT, ROLLAND, ANNE, ROMAIN, BOURCIER, GONDON, EMMANUELLE, SEDAT, JACQUES, AUZOU, PASCAL, OZSANCAK, CANAN, CAMI, GUILLAUME, NEAU, JEAN PHILIPPE, RAYNAUD, NICOLAS, VELASCO, STÉPHANE, VANNIER, STEPHANE, DAMAJ, LÉNA, FERRÉ, JEAN CHRISOPHE, EUGENE, FRANCOIS, TRIQUENOT BAGAN, AUDE, PAPAGIANNAKI, CHRISANTHI, WOLFF, VALÉRIE, PEREZ, ALEXANDRA, BEAUJEUX, RÉMY, CHEURET, EMMANUEL, DARCOURT, JEAN, JANOT, KEVIN, PERIVIER, MAXIMILIEN, HERBRETEAUX, DENIS
• Format: Article
• Language: English
• Subjects: Cardiology and cardiovascular system; Cohort analysis; Hemorrhage; Human health and pathology; Ischemia; Life Sciences; Neurology; Online Only; Original Investigation; Pediatrics; Santé publique et épidémiologie; Stroke
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2022.31343

ImportanceThere is to date limited evidence that revascularization strategies are associated with improved functional outcome in children with acute ischemic stroke (AIS).ObjectivesTo report clinical outcomes and provide estimates of revascularization strategy safety and efficacy profiles of intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) in children with AIS.Design, Setting, and ParticipantsThe KidClot multicenter nationwide cohort study retrospectively collected data of children (neonates excluded) with AIS and recanalization treatment between January 1, 2015, and May 31, 2018. Data analysis was performed from January 1, 2015, to May 31, 2019.ExposureIVT and/or EVT.Main Outcomes and MeasuresPrimary outcome was day 90 favorable outcome (modified Rankin Scale [mRs] 0-2, with 0 indicating no symptoms and 6 indicating death). Secondary end points included 1-year favorable outcome (mRs, 0-2), mortality, and symptomatic intracerebral hemorrhage. Other measures included the Pediatric National Institutes of Health Stroke Scale (pedNIHSS), with pedNIHSS 0 indicating no symptoms, 1 to 4 corresponding to a minor stroke, 5 to 15 corresponding to a mild stroke, greater than 15 to 20: severe stroke, and the adult Alberta Stroke Program Early CT Score (ASPECTS), which provides segmental assessment of the vascular territory, with 1 point deducted from the initial score of 10 for every region involved (from 10 [no lesion] to 0 [maximum lesions]).ResultsOverall, 68 children were included in 30 centers (IVT [n = 44]; EVT [n = 40]; 44 boys [64.7%]; median [IQR] age, 11 [4-16] years; anterior circulation involvement, 57 [83.8%]). Median (IQR) pedNIHSS score at admission was 13 (7-19), higher in the EVT group at 16 (IQR, 10-20) vs 9 (6-17) in the IVT only group (P < .01). Median time from stroke onset to imaging was higher in the EVT group at 3 hours and 7 minutes (IQR, 2 hours and 3 minutes to 6 hours and 24 minutes) vs 2 hours and 39 minutes (IQR, 1 hour and 51 minutes to 4 hours and 13 minutes) (P = .04). Median admission ASPECTS score was 8 (IQR, 6-9). The main stroke etiologies were cardioembolic (21 [30.9%]) and focal cerebral arteriopathy (17 [25.0%]). Median (IQR) time from stroke onset to IVT was 3 hours and 30 minutes (IQR, 2 hours and 33 minutes to 4 hours and 28 minutes). In the EVT group, the rate of postprocedure successful reperfusion (≥modified Treatment in Cerebral Infarction 2b) was 80.0% (32 of 40). Persistent proximal arterial stenosis w