Safety of mechanical thrombectomy in pediatric acute ischemic stroke: a systematic review and meta-analysis.

Purpose: This meta-analysis aimed to evaluate the clinical outcomes and safety of mechanical thrombectomy (MT) in pediatric acute ischemic stroke (AIS).

Methods: Systematic search of PubMed, Embase and Cochrane Library identified studies on MT in children (≤ 18 years) with AIS. Data on baseline characteristics, procedural details and clinical outcomes, including favorable functional outcome (modified Rankin Scale [mRS] 0-2), National Institutes of Health Stroke Scale (NIHSS) reduction, Pediatric Stroke Outcome Measure (PSOM), symptomatic intracranial hemorrhage (sICH) and mortality were extracted. A single-arm meta-analysis was performed to estimate pooled rates.

Results: 25 studies, encompassing 885 patients (mean age of included cohorts: 10.2-18 years), were included. The pooled favorable functional outcome was 80% (95% CI, 70%-88%), while the poor functional outcome was 14% (95% CI: 5%-26%). Mean NIHSS reduction was 8.07 (95% CI, 5.93-10.22), PedNIHSS decrease was 14.64 (95% CI: 12.04 to 17.24), and pooled mean PSOM score at follow-up was 1.02 (95% CI, 0.48-1.55). sICH was 2% (95% CI, 0-5%), need for decompressive hemicraniectomy was 7% (95% CI: 2%-14%) and overall mortality was 4% (95% CI, 1%-8%). Successful recanalization was 88% (95% CI: 81%-95%) and no reperfusion and re-occlusion were both 3% (95% CI: 0%-7%).

Conclusion: MT appears to be a promising and safe treatment option for pediatric AIS, demonstrating high rates of favorable functional outcomes and low mortality/sICH. However, significant heterogeneity among studies highlights the need for further high-quality, standardized research to optimize patient selection and define its effectiveness.