Importance The incidence and natural history of large vessel occlusion (LVO) stroke in children is largely unknown. These knowledge gaps limit the uptake of reperfusion therapies and reduce the efficiency of pediatric acute stroke pathways. Objective To determine the incidence and natural history of pediatric LVO stroke. Design, Setting, and Participants This retrospective population-based cohort study was conducted between January 2010 and December 2019, with a mean (SD) follow-up of 37.0 (28.8) months. Admissions from all pediatric hospitals in the state of New South Wales, Australia, with a final diagnosis of arterial ischemic stroke (AIS) in patients 1 month to younger than 17 years were included. A total of 85 of 251 identified cases were excluded based on selection criteria. Data were analyzed from July 2020 to June 2021. Exposures One-third of patients with LVO received mechanical thrombectomy with or without intravenous thrombolysis while the remainder were treated conservatively. Main Outcomes and Measures The primary outcome was the pediatric modified Rankin Scale (ped-mRS) score 3 months after stroke. Ordinal logistic regression was used to compare non-LVO, LVO without thrombectomy, and LVO with thrombectomy groups. Results Of 161 included patients, 56 (34.8%) were female, and the mean (SD) age was 6.1 (5.4) years. A total of 166 AIS admissions were studied, and clinical follow-up was available for 164 of 166 admissions. LVO was present in 39 admissions (23.5%). The incidence of LVO stroke was 0.24 per 100 000 patients per year (95% CI, 0.13-0.35). Patients with LVO who did not receive thrombectomy (n = 26) had poor neurological outcomes, with 19 (73.1%) experiencing moderate to severe disability or death (ped-mRS score of 3 to 6) at 3 months (6 of 12 patients receiving thrombectomy [50.0%]; 25 of 38 patients with LVO [65.8%]). Patients with LVO without thrombectomy had significantly worse clinical outcomes than patients with non-LVO at 3 months (odds ratio, 3.64; 95% CI, 1.68-7.87; P = .001). Most patients with LVO presented within time windows suitable for thrombectomy (27 of 39 [69.2%] within 6 hours; 35 of 39 [89.7%] within 24 hours). Conclusions and Relevance In this population-based cohort study, the natural history of pediatric patients with LVO stroke treated conservatively was poor, with most experiencing lifelong disability or death. Nearly 90% of pediatric patients with LVO presented within time windows suitable for thrombectomy.

中文翻译：

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小儿大血管闭塞性卒中的发病率和自然史：一项人口研究。

重要性 儿童大血管闭塞 (LVO) 卒中的发病率和自然史在很大程度上是未知的。这些知识差距限制了再灌注疗法的采用，并降低了小儿急性卒中通路的效率。目的 确定小儿 LVO 卒中的发病率和自然病程。设计、设置和参与者 这项基于人群的回顾性队列研究于 2010 年 1 月至 2019 年 12 月期间进行，平均 (SD) 随访时间为 37.0 (28.8) 个月。纳入来自澳大利亚新南威尔士州所有儿科医院并最终诊断为动脉缺血性卒中 (AIS) 的 1 个月至 17 岁以下患者。根据选择标准，排除了 251 例已确定病例中的 85 例。分析了 2020 年 7 月至 2021 年 6 月的数据。暴露 三分之一的 LVO 患者接受机械血栓切除术，伴或不伴静脉溶栓，而其余患者则接受保守治疗。主要结果和测量 主要结果是卒中后 3 个月的儿科改良 Rankin 量表 (ped-mRS) 评分。序数逻辑回归用于比较非 LVO、无血栓切除术的 LVO 和有血栓切除术的 LVO 组。结果 161 例患者中，56 例（34.8%）为女性，平均（SD）年龄为 6.1（5.4）岁。共研究了 166 例 AIS 入院病例，166 例入院病例中有 164 例进行了临床随访。LVO 出现在 39 例入院病例 (23.5%) 中。LVO 卒中的发生率为每年每 100 000 名患者 0.24 例（95% CI，0.13-0.35）。未接受血栓切除术的 LVO 患者 (n = 26) 神经学结果较差，其中 19 例 (73. 1%）在 3 个月时经历中度至重度残疾或死亡（ped-mRS 评分为 3 至 6）（12 名接受血栓切除术的患者中有 6 名 [50.0%]；38 名 LVO 患者中有 25 名 [65.8%]）。未进行血栓切除术的 LVO 患者在 3 个月时的临床结果明显差于非 LVO 患者（比值比，3.64；95% CI，1.68-7.87；P = .001）。大多数 LVO 患者在适合血栓切除术的时间窗内就诊（39 人中的 27 人 [69.2%] 在 6 小时内；39 人中的 35 人 [89.7%] 在 24 小时内）。结论和相关性 在这项基于人群的队列研究中，接受保守治疗的 LVO 卒中儿科患者的自然病程很差，大多数患者终生残疾或死亡。近 90% 的 LVO 儿科患者出现在适合血栓切除术的时间窗内。