Table 4. Technical Outcomes in the Thrombectomy Group.
| Outcome | Thrombectomy group, No. (%) |
|---|---|
| Patients, No. | 26 |
| Thrombectomy procedures, No. | 28 |
| Symptom onset in hospital | 7 (26.9)a |
| Time to clinical presentation, mean (range), min | |
| LSW to arrival at peripheral hospital ED (8 patients) | 247.6 (27-549) |
| LSW to arrival at pediatric/interventional hospital (21 patients)a | 345.9 (51-1170) |
| Peripheral hospital arrival to interventional hospital arrival (9 patients)a | 457.9 (95-960) |
| Time to initial angiographic imaging, mean (range), min | |
| LSW to initial angiographic imaging (CTA, MRA, or DSA) (28 episodes) | 300.9 (34-1264) |
| Initial ED arrival to initial angiographic imaging (20 episodes) | 175.4 (25-1048) |
| Inpatient LSW to initial angiographic imaging (8 episodes) | 221.9 (34-725) |
| Time to recanalization, mean (range), min (28 procedures) | |
| LSW to final recanalization | 695.0 (130-3840) |
| Initial angiographic imaging to DSA suite arrival | 318.4 (10-3105) |
| DSA suite arrival to groin puncture | 24.2 (4-62) |
| Groin puncture to final recanalization | 53.3 (5-135) |
| Time from LSW to final recanalization, time groups (n = 28 procedures) | |
| <6 h | 14 (50.0) |
| 6-12 h | 7 (25.0) |
| 12-24 h | 5 (17.9) |
| >24 h | 2 (7.1) |
| Preprocedure pediatric NIHSS score | |
| Mean (range) | 11.8 (0-22)b |
| Missing data, No. | 7 |
| Postprocedure pediatric NIHSS score at 24 hc | |
| Mean (range) | 4.6 (0-19) |
| Missing data, No. | 9 |
| Reduction in pediatric NIHSS score from prestroke to poststroke | |
| Mean (range) | 6.1 (−3 to 19) |
| Missing data, No. | 10 |
| Recanalization status (mTICI score) | |
| 0 | 0 |
| 1 | 0 |
| 2a | 3 (10.7) |
| 2b | 11 (39.3) |
| 3 | 14 (50.0) |
| Successful recanalization (mTICI score of 2b/3), No./total No. (%) | 25/28 (89.3) |
| No. of passesd | |
| Mean (SD) | 1.9 (1.57) |
| Median (range) | 1.0 (0-7) |
| Most successful recanalization technique | |
| Aspiration only | 3 (10.7) |
| Stent-retriever only | 6 (21.4) |
| Combined stent-retriever and aspiration | 17 (60.7) |
| Balloon angioplasty | 1 (3.6) |
| Intravenous tPA onlyd | 1 (3.6) |
| Additional flow-diverter stent placement | 2 (7.1) |
| Postprocedure intracranial hemorrhage on CT or MRI | |
| Asymptomatic, petechial | 5 (19.2) |
| Asymptomatic, subarachnoid | 2 (7.7) |
| Asymptomatic, lobar | 1 (3.8) |
| Symptomatic, lobar | 1 (3.8) |
| Decompressive craniectomy | |
| For malignant edema | 4 (15.4) |
| For symptomatic lobar hemorrhage | 1 (3.8) |
| Major access site complications | |
| Retroperitoneal hemorrhage | 1 (3.8) |
| Femoral artery pseudoaneurysm | 1 (3.8) |
Abbreviations: CT, computed tomography; CTA, computed tomography angiography; DSA, digital subtraction angiography; ED, emergency department; LSW, last seen well; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; mTICI, modified Treatment in Cerebral Ischaemic; NIHSS, National Institute of Health Stroke Scale; tPA, tissue plasminogen activator.
Seven patients had symptomatic onset of stroke as a hospital inpatient. One patient underwent 2 thrombectomy procedures due to 2 inpatient episodes of occlusion within 96 hours in the same vessel. A second patient had initial symptom onset at home and was treated with thrombectomy but then had recurrent occlusion within 96 hours in the same vessel while an inpatient, leading to a second procedure. A third patient had symptom onset while an inpatient at a peripheral hospital, where they underwent initial angiographic imaging prior to transfer to a pediatric hospital for thrombectomy.
One patient who received thrombectomy had a pediatric NIHSS score of 0 at the time of final treatment decision-making. This patient had a flow-limiting dissection with adjacent thrombus in the intracranial internal carotid artery and presented with mild contralateral hemiparesis that resolved within several hours and was initially managed with heparin infusion. However, 2 additional MRI studies and a CT perfusion study performed in the next 48 hours demonstrated progressive large areas of watershed infarct developing in the ipsilateral deep white matter, and the patient described subjective episodes of receptive dysphasia at night. Based on this, it was decided to proceed to thrombectomy and flow-diverter placement, with successful recanalization at 3840 minutes since last seen well.
Pediatric NIHSS score at 24 hours included scores measured between 20 and 36 hours postprocedure.
One patient who received bridging intravenous tPA en route to the angiography suite after consenting to mechanical thrombectomy had an mTICI score of 3 and successful recanalization on the initial angiographic run and received zero passes.