Neuropediatrics 2016; 47 - FV02-08
DOI: 10.1055/s-0036-1583719

Thrombolysis and Thrombectomy in Children with Acute Ischemic Stroke

A. Dulcey-Husi 1, A. Datta 2, J. Fluss 3, A. Hackenberg 4, O. Meier 5, C. Poloni 6, M. Steinlin 1, S. Bigi 1
  • 1Division of Child Neurology, University Children’s Hospital, Bern, Switzerland
  • 2Division of Child Neurology, University Children’s Hospital, Basel, Switzerland
  • 3Division of Child Neurology, University Children’s Hospital, Geneva, Switzerland
  • 4Division of Child Neurology, University Children’s Hospital, Zurich, Switzerland
  • 5Division of Child Neurology, Children’s Hospital, St. Gallen, Switzerland
  • 6Division of Child Neurology, University Children’s Hospital, Lausanne, Switzerland

Background: Thrombolysis is an established treatment in adults with arterial ischemic stroke (AIS). Case reports suggest, that thrombolysis might be effective in childhood stroke, however, larger studies are lacking. This study describes the effect of thrombolysis/thrombectomy (TT) on outcome in children with AIS.

Methods: Prospective case series of consecutive pediatric AIS patients receiving TT between January 2000 and December 2015. Outcome was assessed using the Pediatric Stroke Outcome Measure (PSOM) at discharge and after 6 months. TT patients were pedNIHSS and age matched with AIS patients receiving standard treatment (ST). The sign test assessed the difference of PSOM in the paired samples.

Results: 15 TT-patients (9 boys, 60%) were compared with a total of 19 ST-patients (9 boys, 47%). Median (range) age and pedNIHSS at stroke onset were 11.9 years (1.5–15.3) and 13 points (7–28) respectively. Median (range) time to diagnosis/treatment-decision in the TT and ST group was four (1–48) and 24 (1–160) hours respectively. I.v. thrombolysis was performed in five, i.a. thrombolysis in four, and thrombectomy in six patients. A total of 2 patients per group died during the acute episode (TT: 13%; ST:10.5%). Median (range) PSOM at discharge and 6 months was 2.5 (0–8) and 1.75 (0–7) in the TT-group and 3.75 (0–10) and 2.0 (0–7) in the ST-group, respectively (p = 0.27; p = 1.0).

Conclusion: Although there is a clinical difference in outcome between the two groups, the results did not reach statistical significance. Larger, prospective studies are needed to identify the subgroup of AIS patients that might benefit best from TT treatment.