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Abstract Details

Potential eligibility for hyperacute treatment in childhood acute arterial ischemic stroke: findings from a single-center 12-year cohort study.
Cerebrovascular Disease and Interventional Neurology
S57 - Acute Treatment and Imaging of Ischemic Stroke (2:17 PM-2:28 PM)
008

Recent changes in practice recommendations for adult acute AIS support mechanical thrombectomy up to 24 hours after last normal in patients meeting specific clinical and radiographic criteria. A lack of randomized, controlled trials in childhood acute AIS limits development of guidelines for treatment with thrombolysis or thrombectomy.

Describe clinical characteristics and presentation timeline of a single-center cohort of children with acute arterial ischemic stroke (AIS) potentially eligible for hyperacute stroke treatment.

113 children with AIS age 30 days-18 years were included in a prospectively-enrolled, consecutive cohort from 2005-2017. Exclusions included insufficient presentation timeline data or delay in diagnosis >2 weeks. A stroke database and charts were reviewed. Pediatric NIH Stroke Scale (PedNIHSS) scores were abstracted from medical records or scored retrospectively.

Mean age at presentation was 8.9 years (80% >2 years, 37% female). 25% were in-hospital strokes. Common risk factors were intracranial vasculopathy in 43 (38%) and cardiac disease in 24 (21%). Of the 69 patients who presented within 4 hours of stroke onset, 56 were >2 years, 19 of those 56 had a PedNIHSS score 6-24, and 7 of those 19 had no medical contraindication to IV-tPA. Four received IV-tPA. Of the 77 patients who presented within 6 hours, 52 were >3 years, 17 of whom had a PedNIHSS score 6-24. Two patients had a mechanical thrombectomy. Of the 94 patients who presented within 24 hours, 65 were >3 years old, 20 of whom had a PedNIHSS score 6-24.

Young age, delay to presentation, and medical contraindication to IV-tPA represent significant barriers to hyperacute intervention in childhood AIS. Twenty-six patients >3 years old had PedNIHSS scores qualifying for potential thrombectomy, but only 17 presented within 6 hours, our current institutional guideline for potential mechanical thrombectomy. Despite challenges, opportunities exist deserving further study to improve acute care in childhood AIS.

Authors/Disclosures
Melissa Hutchinson, MD (ICON)
PRESENTER
Dr. Hutchinson has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Katz, Korin, Cunningham Attorneys At Law.
Alexandra Kimmel No disclosure on file
No disclosure on file
Lauren A. Beslow, MD Dr. Beslow has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various . The institution of Dr. Beslow has received research support from NIH. Dr. Beslow has received publishing royalties from a publication relating to health care.
Lori L. Billinghurst, MD (McMaster Children's Hospital) Dr. Billinghurst has nothing to disclose.
Daniel J. Licht, MD (Children'S Hospital, Philadelphia) No disclosure on file
Evelyn K. Shih, MD, PhD (Neurelis, Inc.) Dr. Shih has received personal compensation for serving as an employee of Neurelis, Inc..
Rebecca N. Ichord, MD (Perelman School of Medicine of the Univ of Pennsylvania) No disclosure on file