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Mechanical Thrombectomy for Pediatric Large Vessel Occlusions

A Systematic Review and Meta-analysis

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Abstract

Background

Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke.

Purpose

To investigate the efficacy and safety of MT in pediatric LVO.

Methods

A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). A fixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI).

Results

In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77–95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09–61.62%) of the cases. The favorable (mRS = 0–2) and excellent (mRS = 0–1) outcome rates were 83.3% (95% CI = 73.54–94.50%) and 59.5% (95% CI = 44.24–80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0–3.30%) and mortality rate was 3.2% (95% CI = 0.55–7.38%).

Conclusion

In our meta-analysis, MT demonstrated a promising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as a first-line treatment strategy.

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Acknowledgements

We would like to thank the Save ChildS and KidClot investigators for sharing their unpublished data.

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Cem Bilgin, Mohamed Ibrahim, Sherief Ghozy, Mohamed Sobhi Jabal, Ramanathan Kadirvel & David F. Kallmes

  2. Faculty of Medicine, October 6 University, 6th of October City, Egypt

    Ahmed Y. Azzam

  3. Uppsala University Faculty of Medicine, Uppsala, Sweden

    Adam Elswedy

  4. College of Medicine, Central Michigan University, Mt. Pleasant, MI, USA

    Hassan Kobeissi

  5. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Ramanathan Kadirvel

  6. Department of Neuroradiology, Université de Tours, CHRU Bretonneau, Tours, France

    Grégoire Boulouis

  7. Department of Neuroradiology, Université de Paris City, INSERM U1266, GHU Paris, Sainte-Anne Hospital, Paris, France

    Olivier Naggara

  8. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jens Fiehler

  9. Department of Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland

    Marios Psychogios

  10. Stanford Stroke Center, Stanford University, Palo Alto, CA, USA

    Sarah Lee

  11. Department of Radiology, University Hospital, LMU Munich, Munich, Germany

    Moritz Wildgruber

  12. Department of Neuroradiology, University Hospital Marburg, Marburg, Germany

    André Kemmling

  13. Department of Neurology, Westchester Medical Center, Valhalla, NY, USA

    Fawaz Al-Mufti

  14. French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France

    Grégoire Boulouis, Olivier Naggara & Manoelle Kossorotoff

  15. Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland

    Peter B. Sporns

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  1. Cem Bilgin
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Correspondence to Cem Bilgin.

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Conflict of interest

J. Fiehler received research support from the German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-/Förderbank (IFB), Medtronic, Microvention, Philips, and Stryker; served as a consultant for Acandis, Bayer, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, and Transverse Medical; has ownership interests in Tegus. D. F. Kallmes received research support from Cerenovus, Insera Therapeutics, Medtronic, Microvention, Balt, Monarch Biosciences, Brainomix, MiVi, and Stryker; received royalties from Medtronic; serves in advisory boards of NoNo Inc. and Vesalio; has ownership interests in Nested Knowledge, Superior Medical Experts, Marblehead Medical, Conway Medical, Monarch Biosciences, and Piraeus Medical. C. Bilgin, M. Ibrahim, A.Y. Azzam, S. Ghozy, A. Elswedy, H. Kobeissi, M. Sobhi Jabal, R. Kadirvel, G. Boulouis, O. Naggara, M. Psychogios, S. Lee, M. Wildgruber, A. Kemmling, F. Al-Mufti, M. Kossorotoff and P.B. Sporns declare that they have no competing interests.

Additional information

The authors Fawaz Al-Mufti, Manoelle Kossorotoff, Peter B. Sporns and David F. Kallmes contributed equally to the manuscript.

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Bilgin, C., Ibrahim, M., Azzam, A.Y. et al. Mechanical Thrombectomy for Pediatric Large Vessel Occlusions. Clin Neuroradiol 33, 635–644 (2023). https://doi.org/10.1007/s00062-022-01246-y

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