Friday, January 27, 2017

Endovascular therapy in pediatric stroke

Jenny L. Wilson, Carl O. Eriksson,  Cydni N. Williams.  Endovascular therapy in pediatric stroke: utilization, patient characteristics, and outcomes.  Pediatric Neurology.  In press.


Background and Purpose

Despite strong evidence for endovascular therapy in adults with acute arterial ischemic stroke, limited data exists in children. We aimed to describe endovascular therapy utilization and explore outcomes in a national sample of pediatric arterial ischemic stroke.

We queried the 2012 Kids’ Inpatient Database for children aged >28 days to 20 years with ICD-9-CM codes for arterial ischemic stroke and evaluated groups based on procedure code for endovascular therapy. Poor outcome was defined as need for tracheostomy or gastrostomy, discharge to rehabilitation facility, or death. Logistic regression evaluated the association between endovascular therapy and poor outcome, adjusted for age, disease severity (hemiplegia, critical care interventions, neurosurgical interventions), and comorbidities.


We identified 3184 pediatric discharges with a diagnosis code for arterial ischemic stroke. Thirty-eight (1%) had an endovascular therapy procedure code. Endovascular therapy patients were older (10.2 versus 4.5 years, p<.001), and more likely to have hemiplegia/paresis (RR 3.8, 95% CI 2.0-7.4), aphasia (RR 5.3, 95% CI 2.8-10.1), and facial droop (RR 4.0, 95% CI 1.9-8.7). Endovascular therapy was not associated with critical care and neurosurgical interventions or intracranial hemorrhage. Length of hospitalization, mortality, and discharge disposition were similar between groups. In a multivariable model, endovascular therapy was not associated with poor outcome (aOR 1.7, 95% CI 0.7-4.1).


In a national sample of children with a diagnosis of arterial ischemic stroke, endovascular therapy was infrequently utilized. Patients with a procedure code for endovascular therapy had significant stroke-related deficits, but outcomes were similar to children who did not receive endovascular therapy. Our data in conjunction with evidence of benefit in adults support consideration of endovascular therapy for select children with acute stroke.

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