Intravenous tPA and Endovascular Thrombectomy Utilization in Pediatric Acute Ischemic Stroke
TAKE-HOME MESSAGE
- The authors of this study examined risk factors, thrombolysis, thrombectomy, and outcomes in 9109 pediatric patients presenting with acute ischemic stroke. Risk factors included epilepsy (19.59%), atrial septal defect (11.76%), sickle cell disease (8.63%), and moyamoya disease (5.41%). Of the patients, 119 (1.30%) underwent intravenous thrombolysis, 256 (2.82%) underwent mechanical thrombectomy, and 69 (0.75%) received both thrombolysis and thrombectomy. Each of these treatment groups had a significantly higher risk of hemorrhagic conversion (5.85%, 8.42%, 7.01%, respectively) compared with the group who received no treatment (1.03%).
- Patients undergoing interventions had higher morbidity and mortality than patients who did not receive treatment, suggesting a strong need for large clinical trials to determine safety and efficacy of stroke treatments in the pediatric population.
– Kyle Binder, MD
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Pediatric stroke is a debilitating disease. There are several risk factors predisposing children to this life-threatening disease. Although, published literature estimates a relatively high incidence of pediatric stroke, treatment guidelines on intravenous tissue plasminogen activator and endovascular thrombectomy utilization remain a dilemma. There is a lack of large population-based studies and clinical trials evaluating the efficacy and safety outcomes associated with these treatments in this unique population.
AIM
We sought to determine the prevalence of risk factors, concurrent utilization of intravenous tissue plasminogen activator and endovascular thrombectomy, and associated outcomes in pediatric stroke hospitalizations.
METHODS
We performed a retrospective analysis of the Nationwide Inpatient Sample data (2003-2014) in pediatric (1-21 years of age) acute ischemic stroke hospitalizations using ICD-9-CM codes. The multivariable survey logistic regression model was weighted to account for sampling strategy, evaluate predictors of hemorrhagic conversion, and treatment outcomes (mortality, morbidity, and discharge disposition) amongst pediatric stroke hospitalizations.
RESULTS
In this analysis, 9109 patients between 1 and 21 years of age were admitted during 2003-2014 for acute ischemic stroke. Of these 9109 patients, 119 (1.30%) received endovascular thrombectomy alone, 256 (2.82%) intravenous recombinant tissue plasminogen activator, and 69 (0.75%) both endovascular thrombectomy and intravenous recombinant tissue plasminogen activator. We found overall high prevalence of conditions like epilepsy (19.59%), atrial septal defect (11.76%), sickle cell disease (8.63%), and moyamoya disease (5.41%) in pediatric acute ischemic stroke patients. Unadjusted analysis showed high prevalence of all-cause in-hospital mortality in combined endovascular thrombectomy and intravenous recombinant tissue plasminogen activator utilization group, and higher prevalence of hemorrhagic conversion and morbidity in endovascular thrombectomy utilization group compared to other groups (p < 0.0001). Multivariate adjusted analysis showed that children with endovascular thrombectomy utilization (aOR: 19.19; 95% CI: 2.50-147.29, p = 0.005), intravenous recombinant tissue plasminogen activator utilization (aOR: 8.85; 95% CI: 1.92-40.76, p = 0.005), and both (endovascular thrombectomy and intravenous recombinant tissue plasminogen activator) utilization (aOR: 7.55; 95% CI: 1.16-49.31, p = 0.035) had higher odds of hemorrhagic conversion compared to no-treatment group.
CONCLUSION
We found various risk factors associated with pediatric stroke. The early identification can be useful to formulate preventive strategies and influence the incidence of pediatric stroke. Our study results showed that use of intravenous recombinant tissue plasminogen activator and endovascular thrombectomy increase risk of mortality and hemorrhagic conversion, but we suggest to have more clinical studies to evaluate the idea candidates for utilization of intravenous recombinant tissue plasminogen activator and endovascular thrombectomy based on risk: benefit ratio.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
Disclosure statements are available on the authors' profiles:
Risk Factors and Outcomes of Intravenous Tissue Plasminogen Activator and Endovascular Thrombectomy Utilization Amongst Pediatrics Acute Ischemic Stroke
Int J Stroke 2020 Feb 02;[EPub Ahead of Print], P Malik, UK Patel, S Kaul, R Singla, T Kavi, K Arumaithurai, VB JaniFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.