Published online before print April 12, 2007, doi: 10.1161/STROKEAHA.107.487116
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(Stroke. 2007;38:1722.)
© 2007 American Heart Association, Inc.
Editorials |
Thrombolysis for Acute Stroke in Pediatrics
From the Stroke Unit, Department of Neurology, USP-Dexeus University Institute, Autonomous University of Barcelona, Barcelona, Spain.
Correspondence to Robert Belvís, Stroke Unit, Department of Neurology, USP-Dexeus University Institute, Autonomous University of Barcelona, Paseo de la Bonanova n 67, E-08017 Barcelona, Spain. E-mail 32353rbn@comb.es
See related article, pages 1850–1854.
Key Words: pediatric stroke • tPA
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Thrombolysis with tissue plasminogen activator (tPA) for patients with acute stroke began in the eighties. After several small series and some pilot trials, the National Institute of Neurological Disorders and Stroke (NINDS) study1 was the first randomized, controlled, double-blind trial that demonstrated with evidences the efficacy and safety of intravenous tPA in acute stroke. However, in all these studies the 3 usual groups of patients: pregnant women, old men and children were excluded on ethical grounds. Therefore, they were also excluded from clinical practice since tPA was approved.
Stroke is an infrequent condition in pediatrics and the etiological subtype distribution is different in children to adult patients. For example, prothrombotic factors account for 68% of strokes in newborns,2 and for 56% in infants and children.3 Other etiologies more frequent in children than in adults are: congenital heart malformations, vascular abnormalities, infectious diseases or some rare metabolic problems. In most of these conditions (cardioembolism, hypercoagulable states), the formed thrombus is fresh and rich in fibrin, the better for the recanalization with tPA.4
Despite the fact that "less than 18 years of age" is an exclusion criterion for thrombolysis, in recent years some pediatric cases have been published.5–14 Most of them are intra-arterial thrombolysis5,6,10–13 with tPA or urokinase and sometimes plus intracranial angioplasty. Moreover, several patients are already young adults (15 to 18 years of age). Although the cases are diverse, the neurological recovery was complete in all of them and neither death nor symptomatic intracranial hemorrhage was reported.
The excellent article
Related Article:
Stroke 2007 38: 1850-1854.