Poor Outcomes Observed for Children With Untreated Large Vessel Occlusion Stroke

For pediatric patients with LVO, 4 out of 5 fulfilled adult thrombectomy selection criteria, aside from age.

According to findings presented at the 2022 International Stroke Conference (ISC), February 9-11, in New Orleans, Louisiana, children with untreated large vessel occlusion (LVO) stroke have poor outcomes, with patients 6 times more likely to have significant disability in the event they do not undergo thrombectomy.

Led by Kartik Bhatia, MBBS, PhD, MS, pediatric interventional neuroradiologist, Sydney Children’s Hospital Network in Westmead, Australia, investigators conducted the multicenter retrospective cohort study that included 166 children with arterial ischemic stroke (AIS) between 2010 and 2019 across 4 centers in New South Wales, Australia. Bhatia et al assessed for Pediatric Modified Rankin Scale scores at 3 months and at final assessment (0-6), as well as eligibility for thrombectomy using the adult trial criteria. Of included patients, who were between the ages of 1 month and 17 years, 39 (23.5%) had LVO, with 12 receiving thrombectomy and 26 not receiving thrombectomy.

At 3 months, those with LVO who did not have thrombectomy had significantly worse outcomes when compared with those who did undergo thrombectomy (odds ratio [OR], 3.64; 95% CI, 1.69-7.87; P = .001). Additionally, long-term outcomes in children with LVO without thrombectomy were much worse than those with LVO who underwent thrombectomy (OR, 6.07; 95% CI, 1.55-23.75; P = .010). The majority of children with LVO presented within time windows suitable for thrombectomy, with 27 children (69.2%) presenting in less than 6 hours and 35 children (89.7%) presenting in less than 24 hours. Thirty-two (82.1%) of the 39 patients with LVO also fulfilled existing adult selection criteria for thrombectomy, aside from age.

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“We were surprised by how common large vessel blockage is in children with stroke and how much worse the disabilities were among the children who did not receive mechanical clot removal, compared to those who did,” Bhatia said in a statement. “Now that we know how poor recovery is for these children who did not receive endovascular therapy, it is much easier to justify treatment options like clot removal for children with a large blood vessel stroke.”

In addition, Bhatia and colleagues suggest triaging and imaging children with LVO earlier.

“Our health systems also need improvement so children with severe stroke are able to receive mechanical clot removal more easily,” Bhatia said in a statement. “These children should be offered treatments to clear the blockages, just like we offer for adults.”

For more coverage of ISC 2022, click here.

REFERENCES
1. Bhatia K. Pediatric large vessel occlusion stroke: poor outcomes without intervention. Presented at ISC 2022; February 9-11; New Orleans, LA and Virtual. Presentation LB1.
2. Children with severe stroke may fare better if treatment includes mechanical clot removal. News release. American Stroke Association. February 11, 2022.https://newsroom.heart.org/news/children-with-severe-stroke-may-fare-better-if-treatment-includes-mechanical-clot-removal?preview=5179