NYMC Faculty Publications

Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke

Alis J. Dicpinigaitis, School of Medicine, New York Medical College, Valhalla (A.J.D.).
Chirag D. Gandhi, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Jared Pisapia, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Carrie R. Muh, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Jared B. Cooper, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Michael Tobias, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Avinash Mohan, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Rolla Nuoman, Department of Neurology (R.N., P.O., S.A.M., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Philip Overby, Department of Neurology (R.N., P.O., S.A.M., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Justin Santarelli, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Simon Hanft, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Christian Bowers, Department of Neurosurgery, University of New Mexico, Albuquerque (C.B.).
Shadi Yaghi, Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (S.Y.).
Stephan A. Mayer, Department of Neurology (R.N., P.O., S.A.M., F.A.-M.), Westchester Medical Center, Valhalla, NY.
Fawaz Al-Mufti, Department of Neurosurgery (C.D.G., J.P., C.R.M., J.B.C., M.T., A.M., J.S., S.H., F.A.-M.), Westchester Medical Center, Valhalla, NY.Follow

Author Type(s)

Faculty

Journal Title

Stroke

First Page

1530

Last Page

1539

Document Type

Article

Publication Date

5-1-2022

Department

Neurosurgery

Second Department

Pediatrics

Third Department

Neurology

Abstract

BACKGROUND: Evidence regarding the utilization and outcomes of endovascular thrombectomy (EVT) for pediatric ischemic stroke is limited, and justification for its use is largely based on extrapolation from clinical benefits observed in adults. METHODS: Weighted discharge data from the National Inpatient Sample were queried to identify pediatric patients with ischemic stroke (<18 years old) during the period of 2010 to 2019. Complex samples statistical methods were used to characterize the profiles and clinical outcomes of EVT-treated patients. Propensity adjustment was performed to address confounding by indication for EVT based on disparities in baseline characteristics between EVT-treated patients and those medically managed. RESULTS: Among 7365 pediatric patients with ischemic stroke identified, 190 (2.6%) were treated with EVT. Utilization significantly increased in the post-EVT clinical trial era (2016-2019; 1.7% versus 4.0%; <0.001), while the use of decompressive hemicraniectomy decreased (2.8% versus 0.7%; <0.001). On unadjusted analysis, 105 (55.3%) EVT-treated patients achieved favorable functional outcomes at discharge (home or to acute rehabilitation), while no periprocedural iatrogenic complications or instances of contrast-induced kidney injury were reported. Following propensity adjustment, EVT-treated patients demonstrated higher absolute but nonsignificant rates of favorable functional outcomes in comparison with medically managed patients (55.3% versus 52.8%; =0.830; adjusted hazard ratio, 1.01 [95% CI, 0.51-2.03]; =0.972 for unfavorable outcome). Among patients with baseline National Institutes of Health Stroke Scale score >11 (75th percentile of scores in cohort), EVT-treated patients trended toward higher rates of favorable functional outcomes compared with those treated medically only (71.4% versus 55.6%; =0.146). In a subcohort assessment of EVT-treated patients, those administered preceding thrombolytic therapy (n=79, 41.6%) trended toward higher rates of favorable functional outcomes (63.3% versus 49.5%; =0.060). CONCLUSIONS: This cross-sectional evaluation of the clinical course and short-term outcomes of pediatric patients with ischemic stroke treated with EVT demonstrates that EVT is likely a safe modality which confers high rates of favorable functional outcomes.

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