1145 Trends in Usage and Efficacy of Endovascular Thrombectomy in Pediatric Acute Ischemic Stroke

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INTRODUCTION: Pediatric acute ischemic stroke (pAIS) is a rare but devastating neurologic emergency, and optimal therapy is still being defined. Endovascular thrombectomy (EVT) and intravascular thrombolysis (IVT) are cornerstones of adult AIS management, yet their use in children remains limited by sparse evidence. Understanding real-world utilization patterns and outcomes is critical for shaping evidence-based guidelines for pAIS treatment. METHODS: A retrospective cross-sectional study was conducted using data from the National inpatient Sample database between January 1st, 2013 and December 31st, 2022. This nationally representative sample included patients <18 years old in the United States, hospitalized with AIS. Propensity score-based inverse probability of treatment weighting (IPTW) adjusted for confounding factors. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for all outcomes. RESULTS: Among 26,070 pAIS hospitalizations, 430 (1.6%) were treated with EVT and 585 (2.2%) were treated with IVT. The median (interquartile range) age of patients receiving EVT was 15 (12-16), and 140 (32.6%) were female. the utilization of EVT steadily increased between 2013 (1.0%) to 2021 (5.3%), although 2022 demonstrated a reversal in the trend. Following IPTW adjustment, EVT was associated with reduced odds of inpatient mortality (OR: 0.089, 95% CI [0.019-0.404], p = 0.002) and equivalent odds of routine discharge (0.635 [0.385-1.05], p = 0.075). IVT was associated with equivalent odds of inpatient mortality (0.982 [0.396-2.43], p = 0.968) and reduced odds of routine discharge (0.566 [0.360-0.889], p = 0.014). CONCLUSIONS: EVT remains infrequently used in pAIS, though it is associated with a reduction of inpatient mortality. Prospective trials are needed to validate these findings and evaluate the clinical benefits of EVT in pAIS.

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