Rebecca Ichord, MD: Addressing Pediatric Stroke With Thrombectomy and Thrombolysis

“We found about 113 cases over that time period who came to our care at CHOP, and about a third of them met one of the major criteria, which is to have a significant deficit from an acute stroke… We found that as many as 15% of children might qualify if they reach an appropriate facility, were quickly evaluated, and had access to care.”

Despite the advent of a number of interventions for stroke in adult patients, such as thrombectomy and thrombolysis, a lack of randomized and controlled trials in pediatric patients with acute arterial ischemic stroke has limited the ability of physicians to develop guidelines for the treatment of these younger patients.

Rebecca Ichord, MD, director, Pediatric Stroke Program, Children’s Hospital of Philadelphia (CHOP), told NeurologyLive^® that raising physicians’ awareness of stroke in pediatric patients is one of the first steps to help alleviate this challenge. Additionally, she and her colleagues, including Melissa Hutchinson, MD, fellow, Division of Neurology, CHOP, conducted a study to explore how many of these patients from their single-center cohort could be potentially eligible for hyperacute stroke treatment.

To do so, they examined data from 2005 to 2017 of patients aged 30 days to 18 years (median age, 8.9 years; 80% were >2 years) with arterial ischemic stroke, and ultimately found 113 cases. Based on their work, they concluded that youth, delayed presentation, and medical contraindication to intravenous-tissue plasminogen activator (tPA) represent significant obstacles for hyperacute intervention in childhood arterial ischemic stroke.

Of the 26 patients older than 3 years who had Pediatric NIH Stroke Scale scores which would have qualified them for potential thrombectomy, only 17 presented within 6 hours—the current institutional guideline for potential mechanical thrombectomy. To discuss this further, Ichord spoke with NeurologyLive^® at the 2019 American Academy of Neurology Annual Meeting in Philadelphia, Pennsylvania.

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REFERENCE

Hutchinson M, Kimmel A, Granath C, et al. Potential eligibility for hyperacute treatment in childhood acute arterial ischemic stroke: findings from a single-center 12-year cohort study. Presented at: 2019 American Academy of Neurology Annual Meeting. May 4-10, 2019; Philadelphia, PA.