Thrombectomy Linked to Improved Outcomes in Pediatric Large Vessel Occlusion

Kartik Bhatia, MBBS, PhD, MS

Data presented at the American Stroke Association’s International Stroke Conference 2022 suggests children were 6 times more likely to experience serious disability 3 months after large vessel occlusion (LVO) if they did not undergo mechanical thrombectomy.

A retrospective analysis of 166 patients aged between 1 month and 17 years from 4 clinics in New South Wales, Australia, results of the study indicate children with stroke and LVO without thrombectomy were 6 times more likely to have moderate to severe disability after three months compared to those who received the procedure.

“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,” said lead researcher Kartik Bhatia, MBBS, PhD, MS, a pediatric interventional neuroradiologist at Sydney Children’s Hospital Network, 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.”

Citing a lack of inclusion in trials assessing thrombectomy in LVO stroke, the current study was designed by Bhatia and colleagues in the Sydney Children’s Hospitals Network to test the group’s hypothesis that children with untreated LVO experience poor outcomes. With this in mind, investigators designed their study as a retrospective analysis of data from all ischemic stroke admission among patients less than 17 years of age from 4 centers in New South Wales, Australia from 2010-2019.

Investigators pointed out the aforementioned time frame, which extends before and after introduction of clot retrieval in adults, allowed for the assessment of natural history of progression. The primary outcome of interest for the analysis was pediatric modified Rankin Scale score 3 months after stroke, which was assessed using ordinal logistic regression to come non-LVO, LVO without thrombectomy, and LVO with thrombectomy cohorts.

Overall, 166 acute ischemic stroke admission were identified. This included 39 with LVO, of which 13 received thrombectomy and 26 did not. The mean age of the non-LVO cohort was 5.48 (SD, 5.23) years and 67.2% were male. The mean age of the LVO cohort was 8.23 (SD, 5.45) years and 59% were male.

Results suggested patients with LVO without thrombectomy had significantly worse clinical outcomes than non-LVO patients at 3 months (OR, 3.64 [95% CI, 1.68-7.87]; P=.001). When comparing outcomes among those with LVO with or without thrombectomy, results suggested those without thrombectomy had significantly worse outcomes than those with thrombectomy (OR, 6.07 [95% CI, 1.55-23.73]; P=.010).

Data indicated the majority of LVO patients presented within time windows considered suitable for thrombectomy, with 69.2% presenting within 6 hours and 89.7% presenting within 24 hours. Investigators noted 82.1% of LVO patients fulfilled existing adult selection criteria for thrombectomy, with the exception of age.

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

This study, “Paediatric Large Vessel Occlusion Stroke: Poor Outcomes Without Intervention,” was presented at ISC 2022.