Mechanical Thrombectomy for Pediatric Stroke: Focal Cerebral Arteriopathy Versus Cardioembolic Etiologies-Pooled Analysis of the Save ChildS and KidClot Cohort

Julien Boucherit; Marios Psychogios; Manoëlle Kossorotoff; Jens Fiehler; Basile Kerleroux; André Kemmling; Olivier Naggara; Sarah Lee; Thi Dan Linh Nguyen-Kim; François Eugene; Moritz Wildgruber; Gregoire Boulouis; Peter B Sporns; Kid Clot and Save ChildS Study Groups

doi:10.1002/ana.27088

Mechanical Thrombectomy for Pediatric Stroke: Focal Cerebral Arteriopathy Versus Cardioembolic Etiologies-Pooled Analysis of the Save ChildS and KidClot Cohort

Ann Neurol. 2024 Oct 10. doi: 10.1002/ana.27088. Online ahead of print.

Authors

Julien Boucherit¹, Marios Psychogios², Manoëlle Kossorotoff³, Jens Fiehler⁴, Basile Kerleroux^{5

6

7}, André Kemmling⁸, Olivier Naggara^{5

6

7}, Sarah Lee⁹, Thi Dan Linh Nguyen-Kim¹⁰, François Eugene¹¹, Moritz Wildgruber¹², Gregoire Boulouis^#^{1

13}, Peter B Sporns^#^{2

4

10}; Kid Clot and Save ChildS Study Groups

Affiliations

¹ Department of Neuroradiology, Tours University Hospital, Tours, France.
² Department of Neuroradiology, University Hospital Basel, Basel, Switzerland.
³ French Center for Pediatric Stroke, France; Pediatric Neurology Department, Assistance publique-Hôpitaux de Paris, INSERM U1266, University Hospital Necker-Enfants maladies, Paris, France.
⁴ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵ GHU Paris Psychiatrie et Neurosciences, CH Sainte-Anne, Inserm, Université de Paris Cité, Paris, France.
⁶ Institut de Psychiatrie et Neurosciences de Paris, Service d'imagerie Morphologique et Fonctionnelle, UMRS1266, Paris, France.
⁷ French Center for Pediatric Stroke, France.
⁸ Department of Neuroradiology, University Marburg, Marburg, Germany.
⁹ Divisions of Child Neurology and Stroke, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
¹⁰ Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland.
¹¹ Interventional Neuroradiology Department, Rennes University Hospital, Rennes, France.
¹² Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
¹³ CIC-IT 1415, CHRU de Tours, INSERM 1253 iBrain, Tours, Centre Val de Loire; French Center for Pediatric Stroke, France.

^# Contributed equally.

PMID: 39390659
DOI: 10.1002/ana.27088

Abstract

Background: The study aimed to compare outcomes of mechanical thrombectomy (MT) in pediatric patients with acute ischemic stroke (AIS) caused by focal cerebral arteriopathy (FCA) versus cardioembolism (CE).

Methods: Data from the Save ChildS and KidClot cohorts were merged. Children with AIS because of FCA or CE that underwent MT were included. The study used the Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation (CASCADE) for stroke cause assessment. Descriptive statistics and multivariable regression models were used to analyze final modified thrombolysis in cerebral infarction (mTICI) scores, periprocedural complications, and functional outcomes assessed by the modified Rankin scale (mRS) at 6 to 12 months.

Results: The analysis included 60 children with 14 FCA and 46 CE cases. CE etiology was associated with better revascularization (good to excellent thrombolysis in cerebral infarction scores) and shift toward better outcomes (common adjusted odds ratio of mRs for CE vs FCA: 0.27, 95% CI: [0.06-0.97], p = 0.039), with no difference in favorable outcome rates. FCA was associated with significantly lower rates of excellent revascularization (21% vs 65%, p < 0.001). No difference in complications' rates was observed between the groups (7.2% in FCA vs 5.5%, p = 0.69).

Interpretation: We found that pediatric AIS because of CE etiology has more favorable procedural outcomes compared to FCA following MT. This translated to mixed functional outcomes that may be more favorable in the CE group. These findings highlight the need for further research to refine treatment protocols for pediatric stroke, particularly in understanding and managing FCA in children. ANN NEUROL 2024.