Abstract Details

Title Endovascular Therapy in Children with Stroke: Evidence from a Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S25 - Emerging Stroke Therapies and Risk Stratification (2:12 PM-2:24 PM)

Poster/Presentation
Number 007

Objective To systematically evaluate the safety and efficacy of endovascular therapy (EVT) compared with best medical treatment (BMT) in pediatric stroke.

Background EVT in pediatric stroke is increasingly reported but remains supported by limited evidence. Important gaps in knowledge have resulted in the absence of clear guidelines for clinical practice. Comparative studies of EVT versus BMT in children have only recently emerged, highlighting the need for a comprehensive synthesis of outcomes.

Design/Methods A comprehensive search was conducted across PubMed, Cochrane, Web of Science, Scopus, and Embase from inception to July 2025. Inclusion criteria were comparative studies, in English, enrolling ≥5 pediatric patients. Outcomes analyzed were any intracranial hemorrhage, mortality and favorable functional outcome (mRS 0–2). Random-effects models in R Studio were used to calculate pooled odds ratios (ORs, 95% CIs) and assess heterogeneity. To account for baseline differences in stroke severity, studies were stratified by Pediatric NIH Stroke Scale: similar baseline severity (p > 0.05), higher severity in the EVT group (p < 0.05), or no available data.

Results Ten studies comprising 20,083 patients were included, of whom 647 underwent EVT. EVT was associated with a significantly higher risk of aICH (OR: 3.12; 95% CI: 1.78–5.47; p < 0.0001) and increased mortality (OR: 3.00; 95% CI: 2.23–4.02; p = 0.0001). No significant difference was observed for favorable functional outcome (OR: 1.55; 95% CI: 0.88–2.88; p = 0.1652).

Conclusions

In this meta-analysis of pediatric stroke, EVT was associated with significantly increased risks of intracranial hemorrhage and mortality compared with BMT. While a numerical trend toward improved functional outcomes was observed, it did not reach statistical significance. Interpretation should be cautious, as differences in baseline stroke severity may influence outcomes. These findings underscore the importance of careful patient selection and highlight the need for further high-quality prospective studies to clarify the role of EVT in this population.

Authors/Disclosures
Mariana Letícia d. Maximiano, MD PRESENTER	Dr. Maximiano has nothing to disclose.
Lucca T. Carretta, Medical student	Mr. Carretta has nothing to disclose.
Rudolfh B. Arend, Sr.	Dr. Arend has nothing to disclose.
Rafael T. Fonseca, Medical Student	Mr. Fonseca has nothing to disclose.
Mariana L. Han, Medical Student	Ms. Han has nothing to disclose.
Bruna Zardin, MD	Miss Zardin has nothing to disclose.
Anderson S. Corin	Mr. Corin has nothing to disclose.
Nicole B. Oliveira	Ms. Oliveira has nothing to disclose.
Pedro Rodrigues Teixeira, Student	Mr. Rodrigues Teixeira has nothing to disclose.
Ocilio R. Goncalves, MS	Mr. Goncalves has nothing to disclose.
FERNANDO R. OLIVEIRA, Sr., PhD	Dr. OLIVEIRA has nothing to disclose.
Tassiane C. Morais, PhD	Prof. Morais has nothing to disclose.
LEANDRO D. BARBOSA, MD, PhD	Prof. BARBOSA has nothing to disclose.
AHMET GÜNKAN, MD	Dr. GÜNKAN has nothing to disclose.

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