Endovascular Therapy in Children with Stroke: Evidence from a Systematic Review and Meta-analysis
Lucca Tamara Alves Carretta1, Mariana Letícia Bastos Maximiano4, Rudolfh Batista Arend5, Rafael Torres Fonseca dos Santos6, Mariana Lee Han7, Bruna Lara Zardin5, Anderson Silva Corin8, Nicole Baptista de Oliveira3, Pedro Rodrigues Teixeira3, Ocílio Ribeiro Gonçalves9, Fernando Rocha Oliveira2, Tassiane Cristina Morais2, Leandro de Assis Barbosa10, AHMET GÜNKAN11
1Medicine, 2Postgraduate department, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), 3Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), 4Federal Fluminense University, 5Federal University of Fronteira Sull, 6Medical Education Institute Vista Carioca, 7University of São Paulo, 8Federal University of Pelota, 9Federal University of Piauí, 10Hospital Estadual Central, 11University of Arizona
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.
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