Systematic review and meta-analysis find stroke thrombectomy safe and effective in children

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A study presented at last week’s Society of NeuroInterventional Surgery (SNIS) annual meeting (31 July–4 August 2023, San Diego, USA) noted that mechanical thrombectomy—in addition to its usage in adults with large vessel occlusion (LVO) stroke—is also safe and effective for treating children.

Owing to the fact that, although thrombectomies are performed in children, data regarding safety and efficacy are “less robust” than in adults, researchers conducted a systematic review and meta-analysis comparing post-thrombectomy outcomes for acute ischaemic stroke due to an LVO in children versus adults.

They reviewed eight studies involving 192 children who received a stroke thrombectomy, and compared these children’s post-thrombectomy improvements with those of adults who underwent the same procedure. Their primary outcome was a change in National Institutes of Health stroke scale (NIHSS) score from presentation to 24 hours after thrombectomy.

The analysis revealed that children experienced better outcomes than adults in many of the study’s secondary measures, including higher rates of good neurological outcomes after surgery (90-day modified Rankin scale [mRS] 0–2; 76.1% vs 46%); better rates of recanalisation (88.5% vs 72.3%); fewer major periprocedural complications (4.7% vs 30.4%), and lower mortality rates (1% vs 12.9%).

In addition, as per the primary outcome, a mean NIHSS score reduction of 7.37 was observed among the included children, while assessments of data from 634 adult patients across five clinical trials demonstrated a mean NIHSS score reduction of 6.87. As such, the magnitude of NIHSS reduction was similar between adults and children.

“Seeing that our best standard treatment for adults with severe stroke is also extremely effective for children is encouraging,” said Matt Findlay (University of Utah School of Medicine, Salt Lake City, USA). “It is very meaningful to know that we can safely use this time-tested, minimally invasive procedure to get children back to their families, recovering quickly, and thriving.”

Writing in the Journal of NeuroInterventional Surgery, where these findings have since been published, the researchers conclude that thrombectomy is safe and effective in paediatric acute ischaemic stroke patients—“endorsing consideration of this intervention in children presenting with LVO”.


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