Abstract 197: Practice and Preparedness for Endovascular Therapy in Acute Pediatric Stroke

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Abstract

Introduction: Endovascular therapy (ET) for pediatric stroke has been described through case reports and series.

Hypothesis: We aimed to determine how pediatric stroke neurologists practice regarding ET, and institutional readiness for this therapy.

Methods: A link to a REDCap survey was emailed to the members of the International Pediatric Stroke Study (IPSS), which includes 58 centers and approximately 150 investigators, requesting responses from physicians who manage acute stroke.

Results: We received 42 responses, with 12 countries represented. Most respondents were pediatric neurologists (n=33), with a median 10 years of experience treating pediatric stroke (SD 6.8). Fourteen (33%) had never recommended/performed ET, 10 (24%) had treated 1-2 patients, and 17 (40%) had treated 3-10 patients. All but one respondent would consider ET in a child. The mean minimum age for consideration of ET was 3 years (range 2-12 years), however most (n=27) had no set minimum age. Most used a time-window of 6 (33%) or 8 (24%) hours for anterior circulation stroke, though 38% had no set time window. Only 7 respondents reported a minimum NIHSS (median NIHSS 6, range 4-15), with the remainder reporting that deficits needed to be significant or the decision would dependent on the clinical scenario. The institutional analyses included only the responses of the 25 IPSS principal investigators to ensure just one response per institution. Fifty-six percent reported that ET would be performed at a children’s hospitals, 36% at an adjacent hospital, and 4% reported that ET would be performed off-site, with 67% responding that patients would need to travel > 10 miles. Only 3 reported working with interventional neuroradiologists who primarily or exclusively treated children, however 22 (88%) worked with adult interventional neuroradiologists comfortable treating children. Twenty (80%) reported having institutional ET guidelines in place or in development.

Conclusions: Pediatric stroke neurologists were largely willing to consider ET, though many had limited experience. With varied clinician expertise and hospital settings, consensus-based guidelines would need to include minimum requirements for institutions to perform ET.

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