The standard of care for stroke treatment in adults changed rapidly in 2015 after results from 5 major clinical trials each showed efficacy of endovascular treatment of anterior circulation large-vessel occlusion within 6 hours of stroke onset.^1-5 The positive results of these studies have since raised questions about whether endovascular therapy should be used for children who present with stroke due to large-vessel occlusion and, other than age, fit adult criteria for thrombectomy. Compared with the occurrence in adults, ischemic stroke in children is uncommon, but remains important to address because the resulting disability from a stroke in a child is costly at individual and societal levels.⁶ While it would be ideal to conduct a randomized trial to test efficacy of endovascular treatment in children, this type of study would be challenging owing to slow participant accrual. Few adult stroke trials have included children, and, to our knowledge, there have been no large, randomized efficacy trials of acute stroke treatment aimed specifically for children. The lack of clinical trials in pediatric stroke poses challenges to clinicians who are left to extrapolate best practices from research conducted in adults. On the strength of adult studies, in 2015, the American Heart Association/American Stroke Association guidelines suggested that mechanical thrombectomy with stent retrievers was reasonable to consider for some patients younger than 18 years with large-vessel occlusion.⁷

在5项主要临床试验的结果均显示在中风发作6小时内对前循环大血管闭塞进行血管内治疗后，成人中风治疗的护理标准在2015年发生了迅速变化。^{1 -5}此后，这些研究的积极结果引起了人们的疑问：是否应对因大血管闭塞而除年龄以外的成年人，适合成人进行血栓切除术的患儿使用血管内治疗。与成年人相比，儿童缺血性中风并不常见，但仍很重要，因为儿童中风导致的残疾在个人和社会层面上都是昂贵的。⁶尽管理想的是进行一项随机试验以测试儿童血管内治疗的疗效，但由于参与者的累积缓慢，这种类型的研究将具有挑战性。很少有成人中风试验包括儿童，据我们所知，还没有针对儿童的急性中风治疗的大型随机疗效试验。缺乏儿童卒中的临床试验给临床医生带来了挑战，他们只能从成人研究中推断出最佳实践。基于成人研究的优势，2015年，美国心脏协会/美国中风协会指南建议，对于一些18岁以下大血管闭塞的患者，考虑采用机械支架支架血栓切除术是合理的。⁷