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October 14, 2019

Endovascular Therapy for Childhood Stroke—Working Together to Reach Prime Time

Author Affiliations
  • 1Departments of Neurology and Pediatrics, University of California, San Francisco
  • 2Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
JAMA Neurol. 2020;77(1):13-15. doi:10.1001/jamaneurol.2019.3412

The standard of care for stroke treatment in adults changed rapidly in 2015 after results from 5 major clinical trials each showed efficacy of endovascular treatment of anterior circulation large-vessel occlusion within 6 hours of stroke onset.1-5 The positive results of these studies have since raised questions about whether endovascular therapy should be used for children who present with stroke due to large-vessel occlusion and, other than age, fit adult criteria for thrombectomy. Compared with the occurrence in adults, ischemic stroke in children is uncommon, but remains important to address because the resulting disability from a stroke in a child is costly at individual and societal levels.6 While it would be ideal to conduct a randomized trial to test efficacy of endovascular treatment in children, this type of study would be challenging owing to slow participant accrual. Few adult stroke trials have included children, and, to our knowledge, there have been no large, randomized efficacy trials of acute stroke treatment aimed specifically for children. The lack of clinical trials in pediatric stroke poses challenges to clinicians who are left to extrapolate best practices from research conducted in adults. On the strength of adult studies, in 2015, the American Heart Association/American Stroke Association guidelines suggested that mechanical thrombectomy with stent retrievers was reasonable to consider for some patients younger than 18 years with large-vessel occlusion.7

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