Does Device Selection Impact Recanalization Rate and Neurological Outcome?

Stroke, vol. 51, pp. 1182–1189

Abstract

Background and Purpose- The recent Save ChildS study provides multicenter evidence for the use of mechanical thrombectomy in children with large vessel occlusion arterial ischemic stroke. However, device selection for thrombectomy may influence rates of recanalization, complications, and neurological outcomes, especially in pediatric patients of different ages. We, therefore, performed additional analyses of the Save ChildS data to investigate a possible association of different thrombectomy techniques and devices with angiographic and clinical outcome parameters. Methods- The Save ChildS cohort study (January 2000-December 2018) analyzed data from 27 European and United States stroke centers and included all pediatric patients (<18 years), diagnosed with arterial ischemic stroke who underwent endovascular recanalization. Patients were grouped into first-line contact aspiration (A Direct Aspiration First Pass Technique [ADAPT]) and non-ADAPT groups as well as different stent retriever size groups. Associations with baseline characteristics, recanalization rates (modified Treatment in Cerebral Infarction), complication rates, and neurological outcome parameters (Pediatric National Institutes of Health Stroke Scale after 24 hours and 7 days; modified Rankin Scale and Pediatric Stroke Outcome Measure at discharge, after 6 and 24 months) were investigated. Results- Seventy-three patients with a median age of 11.3 years were included. Currently available stent retrievers were used in 59 patients (80.8%), of which 4×20 mm (width×length) was the most frequently chosen size (36 patients =61%). A first-line ADAPT approach was used in 7 patients (9.6%), and 7 patients (9.6%) were treated with first-generation thrombectomy devices. In this study, a first-line ADAPT approach was neither associated with the rate of successful recanalization (ADAPT 85.7% versus 87.5% No ADAPT) nor with the complication rate or the neurological outcome. Moreover, there were no associations of stent retriever sizes with rates of recanalization, complication rates, or outcome parameters. Conclusions- Our study suggests that neurological outcomes are generally good regardless of any specific device selection and suggests that it is important to offer thrombectomy in eligible children regardless of technique or device selection. Registration- URL: https://www.drks.de/; Unique identifier: DRKS00016528.

Authors 42

1. Peter Bernhard Sporns corresponding

   University Hospital Münster

   Affiliation as printed

   From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany

2. Ronald Straeter

   University Hospital Münster

   Affiliation as printed

   Department of Pediatrics (R.S.), University Hospital of Muenster, Germany

   Ronald Straeter Department of Pediatrics (R.S.), University Hospital of Muenster, Germany

3. Jens Minnerup

   University of Münster · University Hospital Münster

   Affiliation as printed

   Department of Neurology (J.M., H.W.), University Hospital of Muenster, Germany

   Jens Minnerup Department of Neurology (J.M., H.W.), University Hospital of Muenster, Germany

4. Heinz Wiendl

   University of Münster · University Hospital Münster

   Affiliation as printed

   Department of Neurology (J.M., H.W.), University Hospital of Muenster, Germany

   Heinz Wiendl Department of Neurology (J.M., H.W.), University Hospital of Muenster, Germany

5. Uta Meta Paula Hanning

   University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)

   Uta Hanning Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)

6. René Chapot

   Alfried Krupp Hospital

   Affiliation as printed

   Department of Neuroradiology, Alfried-Krupp Hospital, Essen, Germany (R.C.)

7. Hans H. Henkes

   Klinikum Stuttgart

   Affiliation as printed

   Department of Neuroradiology, Klinikum Stuttgart, Germany (H.H., E.H.)

   Hans Henkes Department of Neuroradiology, Klinikum Stuttgart, Germany (H.H., E.H.)

8. Elina Henkes

   Klinikum Stuttgart

   Affiliation as printed

   Department of Neuroradiology, Klinikum Stuttgart, Germany (H.H., E.H.)

   Elina Henkes Department of Neuroradiology, Klinikum Stuttgart, Germany (H.H., E.H.)

9. Astrid Ellen Grams

   Innsbruck Medical University · Universität Innsbruck

   Affiliation as printed

   Department of Neuroradiology, Medical University of Innsbruck, Austria (A.G.)

   Astrid Grams Department of Neuroradiology, Medical University of Innsbruck, Austria (A.G.)

10. Franziska Dorn

    Ludwig-Maximilians-Universität München

    Affiliation as printed

    Department for Diagnostic and Interventional Neuroradiology, University of Munich (LMU), Campus Grosshadern, Munich, Germany (F.D.)

    Franziska Dorn Department for Diagnostic and Interventional Neuroradiology, University of Munich (LMU), Campus Grosshadern, Munich, Germany (F.D.)

11. Omid Nikoubashman Aachen Department of Neuroradiology Omid Nikoubashman Department of Neuroradiology

    RWTH Aachen University

    Affiliation as printed

    Department of Neuroradiology, RWTH Aachen University, Germany (O.N., M. Wiesmann)

    Omid Nikoubashman Department of Neuroradiology, RWTH Aachen University, Germany (O.N., M. Wiesmann)

12. Martin Wiesmann Aachen Department of Neuroradiology Martin Wiesmann Department of Neuroradiology

    RWTH Aachen University

    Affiliation as printed

    Department of Neuroradiology, RWTH Aachen University, Germany (O.N., M. Wiesmann)

    Martin Wiesmann Department of Neuroradiology, RWTH Aachen University, Germany (O.N., M. Wiesmann)

13. Georg Bier

    University Hospital Münster · University of Tübingen

    Affiliation as printed

    Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Germany (G. Bier)

    From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany

    Georg Bier From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Germany (G. Bier)

14. Anushe Weber
    Affiliation as printed

    Department of Radiology and Neuroradiology, Bochum, Germany (A.W.)

    Anushe Weber Department of Radiology and Neuroradiology, Bochum, Germany (A.W.)

15. Gabriel Broocks

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)

    Gabriel Broocks Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)

16. Jens Fiehler

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)

    Jens Fiehler Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)

17. Alex Brehm

    Universitätsmedizin Göttingen · University of Göttingen

    Affiliation as printed

    Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Germany (A.B., M.P.)

    Alex Brehm Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Germany (A.B., M.P.)

18. Marios‐Nikos Psychogios

    Universitätsmedizin Göttingen · University of Göttingen

    Affiliation as printed

    Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Germany (A.B., M.P.)

    Marios Psychogios Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Germany (A.B., M.P.)

19. Daniel P. O. Kaiser

    University Hospital Carl Gustav Carus

    Affiliation as printed

    Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany (D.K.)

    Daniel Kaiser Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany (D.K.)

20. Umut Yılmaz

    Universitätsklinikum des Saarlandes · Saarland University

    Affiliation as printed

    Department of Neuroradiology, Saarland University Hospital, Homburg, Germany (U.Y.)

    Umut Yilmaz Department of Neuroradiology, Saarland University Hospital, Homburg, Germany (U.Y.)

21. Andrea Morotti

    Fondazione Istituto Neurologico Nazionale Casimiro Mondino

    Affiliation as printed

    Department of Neurology and Neurorehabilitation, IRCCS Mondino Foundation, Pavia, Italy (A.M.)

    Andrea Morotti Department of Neurology and Neurorehabilitation, IRCCS Mondino Foundation, Pavia, Italy (A.M.)

22. Wolfgang Marik

    Medical University of Vienna

    Affiliation as printed

    Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria

    Wolfgang Marik Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria

23. Richard Nolz

    Medical University of Vienna

    Affiliation as printed

    Division of Cardiovascular and Interventional Radiology (R.N.), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria

    Richard Nolz Division of Cardiovascular and Interventional Radiology (R.N.), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria

24. Ulf Jensen‐Kondering

    University Hospital Schleswig-Holstein

    Affiliation as printed

    Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany (U.J.-K.)

    Ulf Jensen-Kondering Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany (U.J.-K.)

25. Bernd Schmitz

    Universität Ulm

    Affiliation as printed

    Section of Neuroradiology, University of Ulm, Guenzburg, Germany (B.S.)

    Bernd Schmitz Section of Neuroradiology, University of Ulm, Guenzburg, Germany (B.S.)

26. Stefan Schob

    University Hospital Leipzig

    Affiliation as printed

    Department for Neuroradiology, University Hospital Leipzig, Germany (S.S.)

    Stefan Schob Department for Neuroradiology, University Hospital Leipzig, Germany (S.S.)

27. Oliver Beuing

    University Hospital Magdeburg

    Affiliation as printed

    Department of Neuroradiology, University Hospital of Magdeburg, Germany (O.B.)

    Oliver Beuing Department of Neuroradiology, University Hospital of Magdeburg, Germany (O.B.)

28. Friedrich Goetz

    Medizinische Hochschule Hannover

    Affiliation as printed

    Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Germany (F.G.)

    Friedrich Goetz Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Germany (F.G.)

29. Johannes Trenkler

    Johannes Kepler University of Linz · Kepler Universitätsklinikum

    Affiliation as printed

    Institute of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, Austria (J.T.)

    Johannes Trenkler Institute of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, Austria (J.T.)

30. Bernd Turowski

    Düsseldorf University Hospital

    Affiliation as printed

    Institute of Neuroradiology, University Hospital Duesseldorf, Germany (B.T.)

    Bernd Turowski Institute of Neuroradiology, University Hospital Duesseldorf, Germany (B.T.)

31. Markus Alfred Möhlenbruch

    University Hospital Heidelberg

    Affiliation as printed

    Department of Neuroradiology at Heidelberg University Hospital, Germany (M.M.)

32. Christina M. Wendl

    University Hospital Regensburg

    Affiliation as printed

    Department of Radiology, University Hospital Regensburg, Germany (C.W.)

    Christina Wendl Department of Radiology, University Hospital Regensburg, Germany (C.W.)

33. Peter W. Schramm

    University of Lübeck

    Affiliation as printed

    Department of Neuroradiology, University Hospital of Luebeck, Germany (P.S.)

    Peter Schramm Department of Neuroradiology, University Hospital of Luebeck, Germany (P.S.)

34. Patricia Leonor Musolino

    Harvard University · Massachusetts General Hospital

    Affiliation as printed

    Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (P.M.)

    Patricia Musolino Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (P.M.)

35. Sarah Lee

    Stanford Medicine · Stanford University

    Affiliation as printed

    Division of Child Neurology, Department of Neurology, Stanford University, California (S.L.)

    Sarah Lee Division of Child Neurology, Department of Neurology, Stanford University, California (S.L.)

36. Marc Schlamann

    University Hospital Cologne

    Affiliation as printed

    Department of Neuroradiology, University Hospital of Cologne, Germany (M.S.)

    Marc Schlamann Department of Neuroradiology, University Hospital of Cologne, Germany (M.S.)

37. Alexander Radbruch

    Essen University Hospital · University of Duisburg-Essen

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Germany (A.R.)

    Alexander Radbruch Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Germany (A.R.)

38. Nicole Rübsamen

    University of Münster

    Affiliation as printed

    Institute of Epidemiology and Social Medicine, University of Muenster, Germany (N.R., A. Karch)

39. André Karch

    University of Münster

    Affiliation as printed

    Institute of Epidemiology and Social Medicine, University of Muenster, Germany (N.R., A. Karch)

40. Walter Leonhard Heindel

    University Hospital Münster

    Affiliation as printed

    From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany

    Walter Heindel From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany

41. Moritz Wildgruber

    University Hospital Münster

    Affiliation as printed

    From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany

    Moritz Wildgruber From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany

42. André Kemmling

    Heidelberg University · Westpfalz Klinikum

    Affiliation as printed

    Department of Neuroradiology, Westpfalz-Klinikum Kaiserslautern, Germany (A. Kemmling)

    Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany (A. Kemmling)