Mechanical thrombectomy versus medical management for pediatric ischemic stroke: a systematic review and meta-analysis of comparative studies.

Abstract

Ischemic stroke is an important cause of morbidity and mortality in children, yet no clinical trials have evaluated mechanical thrombectomy (MT) in this population. Consequently, in contrast to adults, pediatric MT remains an off-label intervention. This meta-analysis aimed to assess its safety and efficacy and compare outcomes with medical management (MM). MEDLINE, Scopus, and Web of Science were searched to identify original studies reporting outcomes of MT, with or without intravenous thrombolysis (IVT) in pediatric ischemic stroke. In studies that concurrently reported MT±IVT and MM±IVT within the same study, outcomes from the MM arms were also extracted for comparative analysis. Eighteen studies encompassing 612 pediatric patients were included. The pooled successful recanalization rate (thrombolysis in cerebral infarction (TICI) 2b-3) after mechanical thrombectomy was 88.9% (95% confidence interval (CI) 85.65 to 92.06), and 43.9% (95% CI, 38.67 to 49.09) achieved complete recanalization (TICI 3). Favorable functional outcomes (modified Rankin Scale (mRS) 0-2) occurred in 78.6% (95% CI, 69.58 to 87.61) of patients, with mortality and symptomatic intracranial hemorrhage (sICH) rates of 3.9% (95% CI, 1.88 to 5.92) and 1.3% (95% CI, 1.07 to 2.58), respectively. Shift analysis demonstrated a significant overall improvement in functional outcomes with MT±IVT compared with MM±IVT (common (OR), 0.43; 95% CI, 0.30 to 0.63; P<0.001). Our findings suggest that MT has a favorable safety and efficacy profile, resulting in a more favorable mRS shift compared with MM in pediatric ischemic stroke. Further research is needed to identify the pediatric stroke patients who are likely to benefit from MT.