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.

中文翻译：

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国家一级小儿缺血性卒中血管内介入治疗的趋势：2000 年至 2009 年的数据。

目的

目前关于小儿急性缺血性卒中 (AIS) 的血管内和介入治疗的知识有限。通过国家数据库分析了该人群中当前的神经干预实践。

方法

对 2000 年、2003 年、2006 年和 2009 年的儿童住院患者数据库进行了检查，检查了年龄小于 18 岁且初步诊断为 AIS 并根据 ICD-9 代码进行识别的患者。每个亚组的描述性统计数据被制成表格。

结果

确定了 3467 名患者；920 例（26.5%）接受了血管造影，51 例（1.5%）接受了血管造影+溶栓治疗，18 例（0.5%）接受了血管造影+血管内再通。与溶栓和血管内手术亚组相比，仅血管造影亚组显着更年轻（9.8 岁 vs. 12.2 岁 vs. 14.9 岁，P < 0.001）。死亡率为 4.3%，仅血管造影显着低于溶栓（1.1% 对 18.2%，P < 0.0001）。溶栓治疗的住院费用也显着增加（149,045 美元对 64,826 美元，P < 0.0001）。虽然仅血管造影与血管内手术的结果差异不大，但后者的经济负担更高（122,482 美元对 64,826 美元，P < 0.0001）。

结论

这项全国性研究表明，接受神经干预的儿童往往年龄较大（> 12 岁），心脏和瓣膜缺陷是他们最可能的合并症。与单独的静脉内/动脉内溶栓相比，血管内手术的死亡率和并发症更少。溶栓还与更多的非常规出院和更长的停留时间有关。