TY - JOUR
T1 - Trends in endovascular interventions for pediatric ischemic stroke at the national level
T2 - data from 2000 to 2009
AU - Shweikeh, Faris
AU - Nuno, Miriam
AU - Adamo, Matthew
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Purpose: Present knowledge is limited with regard to endovascular and interventional management of pediatric acute ischemic stroke (AIS). The current practice of neurointerventions in this population was analyzed via a national database. Methods: The Kids’ Inpatient Database for years 2000, 2003, 2006, and 2009 was examined for patients aged < 18 years discharged with a primary diagnosis of AIS and identified according to ICD-9 codes. Descriptive statistics were tabulated on each of the subcohorts. Results: There were 3467 patients identified; 920 (26.5%) underwent angiograms, 51 (1.5%) angiogram + thrombolysis, and 18 (0.5%) received angiogram + endovascular recanalization. The angiogram only subcohort was significantly younger compared with thrombolysis and endovascular procedure subcohorts (9.8 vs. 12.2 vs. 14.9 years, P < 0.001). Mortality was 4.3%, significantly lower for angiogram only than for thrombolysis (1.1% vs. 18.2%, P < 0.0001). Thrombolysis also had significantly higher hospital charges ($149,045 vs. $64,826, P < 0.0001). While not many differences in outcomes between angiogram only versus endovascular procedures, the latter had higher financial burden ($122,482 vs. $64,826, P < 0.0001). Conclusions: This national study suggests that children receiving neurointerventions tend to be older (> 12 years) and heart and valvular defects are their most likely comorbidities. There was a lower mortality and fewer complications with endovascular procedures when compared with intravenous/intraarterial thrombolysis alone. Thrombolysis was also associated with more non-routine discharges and lengthier stay.
AB - Purpose: Present knowledge is limited with regard to endovascular and interventional management of pediatric acute ischemic stroke (AIS). The current practice of neurointerventions in this population was analyzed via a national database. Methods: The Kids’ Inpatient Database for years 2000, 2003, 2006, and 2009 was examined for patients aged < 18 years discharged with a primary diagnosis of AIS and identified according to ICD-9 codes. Descriptive statistics were tabulated on each of the subcohorts. Results: There were 3467 patients identified; 920 (26.5%) underwent angiograms, 51 (1.5%) angiogram + thrombolysis, and 18 (0.5%) received angiogram + endovascular recanalization. The angiogram only subcohort was significantly younger compared with thrombolysis and endovascular procedure subcohorts (9.8 vs. 12.2 vs. 14.9 years, P < 0.001). Mortality was 4.3%, significantly lower for angiogram only than for thrombolysis (1.1% vs. 18.2%, P < 0.0001). Thrombolysis also had significantly higher hospital charges ($149,045 vs. $64,826, P < 0.0001). While not many differences in outcomes between angiogram only versus endovascular procedures, the latter had higher financial burden ($122,482 vs. $64,826, P < 0.0001). Conclusions: This national study suggests that children receiving neurointerventions tend to be older (> 12 years) and heart and valvular defects are their most likely comorbidities. There was a lower mortality and fewer complications with endovascular procedures when compared with intravenous/intraarterial thrombolysis alone. Thrombolysis was also associated with more non-routine discharges and lengthier stay.
KW - Cerebrovascular accident
KW - Endovascular
KW - Ischemic
KW - Pediatric
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U2 - 10.1007/s00381-020-04714-3
DO - 10.1007/s00381-020-04714-3
M3 - Article
C2 - 32529548
AN - SCOPUS:85086400320
JO - Child's Nervous System
JF - Child's Nervous System
SN - 0256-7040
ER -