Relationship Between Baseline Infarct and Clinical Outcome in Pediatric Large‐Vessel Occlusion Ischemic Stroke-Reference-Cited by-同舟云学术

Relationship Between Baseline Infarct and Clinical Outcome in Pediatric Large‐Vessel Occlusion Ischemic Stroke

Published:2024-09 Issue:5 Volume:4 Page:
ISSN:2694-5746
Container-title:Stroke: Vascular and Interventional Neurology
language:en
Short-container-title:SVIN

Author:

Bhatia Kartik D.¹^ORCID,Parra‐Farinas Carmen²,Pulcine Elizabeth³,Dlamini Nomazulu³,Andrews Ian⁴,Gupta Sachin¹⁵,Webster Richard¹⁵,Troedson Christopher¹⁵,Dale Russell C.¹⁵,Worthington John⁶,Tastula Kylie⁶,Ang Timothy⁶,Cheung Andrew⁷,Manning Nathan⁷,Miteff Ferdinand⁸,Miteff Christina⁹,Muthusami Prakash²

Affiliation:

1. Children's Hospital at Westmead Clinical School University of Sydney Sydney New South Wales Australia

2. Division of Paediatric Interventional Neuroradiology Hospital for Sick Children Toronto Ontario Canada

3. Division of Neurology Hospital for Sick Children Toronto Ontario Canada

4. Department of Neurology Sydney Children's Hospital Randwick New South Wales Australia

5. T.Y. Nelson Department of Neurology and Neurosurgery Children's Hospital at Westmead Westmead New South Wales Australia

6. Department of Neurology Royal Prince Alfred Hospital Camperdown New South Wales Australia

7. Division of Interventional Neuroradiology Prince of Wales Hospital Randwick New South Wales Australia

8. Department of Neurology John Hunter Hospital New Lambton Heights New South Wales Australia

9. Department of Neurology John Hunter Children's Hospital New Lambton Heights New South Wales Australia

Abstract

Background In adults with large‐vessel occlusion stroke, the extent of the baseline infarct measured using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) predicts outcome and is used during patient selection for mechanical thrombectomy. The relationship between ASPECTS and clinical outcome is unknown in pediatric large‐vessel occlusion stroke. Methods Secondary analysis of a retrospective multicenter case–control study assessing mechanical thrombectomy versus medical management alone for pediatric large‐vessel occlusion stroke across 5 centers in Australia and Canada from 2011 to 2022. ASPECTS was measured on baseline computed tomography or magnetic resonance imaging–diffusion‐weighted imaging while blinded to clinical outcome and treatment status. The relationship between ASPECTS and pediatric modified Rankin scale scores at 3 months following stroke was assessed using ordinal logistic regression. Results In total, n = 24 thrombectomy patients (F = 10, mean age, 11.3 years [SD, 4.36]) and n = 24 control patients (F = 10, mean age, 10.2 years [SD, 4.32) were included. Mean ASPECTS was 6.3 (SD, 2.37) in the thrombectomy group and 6.1 (SD, 2.64) in the control group. In patients undergoing thrombectomy, baseline ASPECTS significantly correlated with pediatric modified Rankin scale scores at 3 months (odds ratio, 1.58 [95% CI, 1.10–2.27]; P = 0.013). In control patients, there was no significant correlation (odds ratio, 1.17 [95% CI, 0.87–1.55]; P = 0.298). Six of 7 thrombectomy patients with a large baseline infarct (ASPECTS <6) had a pediatric modified Rankin scale score of 0 to 2 at final follow‐up. Conclusion Baseline ASPECTS was significantly associated with clinical outcome in pediatric patients with large‐vessel occlusion stroke who received mechanical thrombectomy. Thrombectomy patients with low ASPECTS demonstrated favorable long‐term outcomes, suggesting ASPECTS alone should not be used to exclude pediatric patients from receiving thrombectomy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference17 articles.

1. Incidence and Natural History of Pediatric Large Vessel Occlusion Stroke

2. Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke

3. Association Between Thrombectomy and Functional Outcomes in Pediatric Patients With Acute Ischemic Stroke From Large Vessel Occlusion

4. Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke

5. Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association