Mechanical Thrombectomy for Pediatric Large Vessel Occlusions: A Systematic Review and Meta-analysis

Cem Bilgin, Mohamed Ibrahim, Ahmed Y. Azzam, Sherief Ghozy, Adam Elswedy, Hassan Kobeissi, Mohamed Sobhi Jabal, Ramanathan Kadirvel, Grégoire Boulouis, Olivier Naggara, Jens Fiehler, Marios Psychogios, Sarah Lee, Moritz Wildgruber, André Kemmling, Fawaz Al-Mufti, Manoelle Kossorotoff, Peter B. Sporns, David F. Kallmes

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalClinical Neuroradiology
DOIs
StateAccepted/In press - 2023

Keywords

  • Adolescent
  • Children
  • Endovascular
  • Ischemic
  • Stroke

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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