儿童急性缺血性脑卒中静脉溶栓研究进展

doi:10.12372/jcp.2025.24e0747

Abstract

Abstract:

Pediatric acute ischemic stroke is a rare condition with a poor prognosis and significant recurrence rates. Intravenous tissue plasminogen activator (IV-TPA) has been proven to be an effective treatment for acute ischemic stroke (AIS) in adults, but it has not been licensed for use in children. The safety and efficacy of IV-TPA in children should be investigated further. This article reviews the research on IV-TPA treatment in children with pediatric acute ischemic stroke.

Key words: pediatric acute ischemic stroke, alteplase, intravenous thrombolysis, efficacy, safety

CHENG Siyi, WU Xiushu. Progress of intravenous thrombolysis in pediatric acute ischemic stroke[J].Journal of Clinical Pediatrics, 2025, 43(4): 318-322.

References 42

[1]	Mao R, Zong N, Hu Y, et al. Neuronal death mechanisms and therapeutic strategy in ischemic stroke[J]. Neurosci Bull, 2022, 38(10): 1229-1247. doi: 10.1007/s12264-022-00859-0 pmid: 35513682
[2]	《中国脑卒中防治报告2021》编写组, 王陇德. 《中国脑卒中防治报告2021》概要[J]. 中国脑血管病杂志, 2023, 20(11): 783-792.
	Report on Stroke Prevention and Treatment in China Writing Group, Wang LD. Summary of the report on stroke prevention and treatment in China 2021[J]. Zhongguo Naoxueguanbing Zazhi, 2023, 20(11): 783-792.
[3]	Li G, Wang C, Wang S, et al. Tenecteplase in ischemic stroke: challenge and opportunity[J]. Neuropsychiatr Dis Treat, 2022, 18: 1013-1026.
[4]	Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischemic stroke: a meta-analysis of individual patient data from randomized trials[J]. Lancet, 384(9958): 1929-1935.
[5]	Grunwald IQ, Walter S, Fassbender K, et al. Ischemic stroke in children: new aspects of treatment[J]. J Pediatr, 2011, 159(3): 366-370.
[6]	Farnoux C, Camard O, Pinquier D, et al. Recombinant tissue-type plasminogen activator therapy of thrombosis in 16 neonates[J]. J Pediatr, 1998, 133(1): 137-140.
[7]	Weiner GM, Castle VP, Dipietro MA, et al. Successful treatment of neonatal arterial thromboses with recombinant tissue plasminogen activator[J]. J Pediatr, 1998, 133(1): 133-136.
[8]	Ferriero DM, Fullerton HJ, Bernard TJ, et al. Management of stroke in neonates and children: A Scientific Statement From the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50(3): e51-e96. doi: 10.1161/STR.0000000000000183
[9]	Felling RJ, Sun LR, Maxwell EC, et al. Pediatric arterial ischemic stroke: Epidemiology, risk factors, and management[J]. Blood Cells Mol Dis, 2017, 67: 23-33.
[10]	Medley TL, Miteff C, Andrews I, et al. Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke[J]. Int J Stroke, 2019, 14(1): 94-106. doi: 10.1177/1747493018799958 pmid: 30284961
[11]	Sun LR, Lynch JK. Advances in the diagnosis and treatment of pediatric arterial ischemic stroke[J]. Neurotherapeutics, 2023, 20(3): 633-654. doi: 10.1007/s13311-023-01373-5 pmid: 37072548
[12]	Ellis C, Mcgrattan K, Mauldin P, et al. Costs of pediatric stroke care in the United States: a systematic and contemporary review[J]. Expert Rev Pharmacoecon Outcomes Res, 2014, 14(5): 643-650.
[13]	Numis AL, Fox CK. Arterial ischemic stroke in children: risk factors and etiologies[J]. Curr Neurol Neurosci Rep, 2014, 14(1): 422.
[14]	Lanthier S, Carmant L, David M, et al. Stroke in children: the coexistence of multiple risk factors predicts poor outcome[J]. Neurology, 2000, 54(2): 371-378. pmid: 10668698
[15]	Gao L, Zhang S, Wo X, et al. Intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction[J]. Pak J Med Sci, 2022, 38(3Part-I): 498-504. doi: 10.12669/pjms.38.3.4521 pmid: 35480520
[16]	Yasaka M, O’Keefe GJ, Chambers BR, et al. Streptokinase in acute stroke: effect on reperfusion and recanalization. Australian Streptokinase Trial Study Group[J]. Neurology, 1998, 50(3): 626-632. pmid: 9521247
[17]	Zhang R, Wei H, Ren Y, et al. Outcomes and treatment complications of intravenous urokinase thrombolysis in acute ischemic stroke in China[J]. Front Neurol, 2021, 12: 685454.
[18]	Coutts SB, Berge E, Campbell BC, et al. Tenecteplase for the treatment of acute ischemic stroke: A review of completed and ongoing randomized controlled trials[J]. Int J Stroke, 2018, 13(9): 885-892. doi: 10.1177/1747493018790024 pmid: 30035698
[19]	Warach SJ, Dula AN, Milling TJ. Tenecteplase thrombolysis for acute ischemic stroke[J]. Stroke, 2020, 51(11): 3440-3451. doi: 10.1161/STROKEAHA.120.029749 pmid: 33045929
[20]	Haire WD. Pharmacology of fibrinolysis[J]. Chest, 1992, 101(4, Supplement): 91S-97S.
[21]	Yan S, Zhang X, Zhang R, et al. Early fibrinogen depletion and symptomatic intracranial hemorrhage after reperfusion therapy[J]. Stroke, 2019, 50(10): 2716-2721. doi: 10.1161/STROKEAHA.119.025711 pmid: 31394994
[22]	Yaghi S, Willey JZ, Cucchiara B, et al. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke, 2017, 48(12): e343-e361.
[23]	Romoli M, Giannandrea D, Zini A. Fibrinogen depletion and intracerebral hemorrhage after thrombolysis for ischemic stroke: a meta-analysis[J]. Neurol Sci, 2022, 43(2): 1127-1134.
[24]	Monagle P, Chan AK, Albisetti M, et al. Fibrinolytic system in adolescents: response to venous occlusion stress tests. Pediatr Res[J]. Pediatr Res, 2003, 53(2):333-337. doi: 10.1203/01.PDR.0000047644.97422.F2 pmid: 12538795
[25]	Ignjatovic V, Pelkmans L, Kelchtermans H, et al. Differences in the mechanism of blood clot formation and nanostructure in infants and children compared with adults[J]. Thromb Res, 2015, 136(6): 1303-1309. doi: 10.1016/j.thromres.2015.10.034 pmid: 26522267
[26]	Fernandez E, Perez R, Hernandez A, et al. Factors and mechanisms for pharmacokinetic differences between pediatric population and adults[J]. Pharmaceutics, 2011, 3(1):53-72. doi: 10.3390/pharmaceutics3010053 pmid: 24310425
[27]	Rivkin MJ, Deveber G, Ichord RN, et al. Thrombolysis in Pediatric Stroke (TIPS) study[J]. Stroke, 2015, 46(3): 880-885.
[28]	Heit JJ, Muthusami P, Chandra RV, et al. Reperfusion therapies for children with arterial ischemic stroke[J]. Top Magn Reson Imaging, 2021, 30(5): 231. doi: 10.1097/RMR.0000000000000273 pmid: 34613946
[29]	Hutchinson ML, Beslow LA, Shih EK, et al. Endovascular and thrombolytic treatment eligibility in childhood arterial ischemic stroke[J]. Eur J Paediatr Neurol, 2021, 34: 99-104.
[30]	Jain SV, Morton LD. Ischemic stroke and excellent recovery after administration of intravenous tissue plasminogen activator[J]. Pediatr Neurol, 2008, 38(2): 126-129. doi: 10.1016/j.pediatrneurol.2007.10.006 pmid: 18206794
[31]	Cremer S, Berliner Y, Warren D, et al. Successful treatment of pediatric stroke with recombinant tissue plasminogen activator (rt-PA): a case report and review of the literature[J]. CJEM, 2008, 10(6): 575-578.
[32]	Alshekhlee A, Geller T, Mehta S, et al. Thrombolysis for children with acute ischemic stroke: a perspective from the kids’ inpatient database[J]. Pediatr Neurol, 2013, 49(5): 313-318. doi: 10.1016/j.pediatrneurol.2013.08.014 pmid: 24139532
[33]	Amlie-Lefond C, Shaw DWW, Cooper A, et al. Risk of intracranial hemorrhage following intravenous tPA (tissue-type plasminogen activator) for acute stroke is low in children[J]. Stroke, 2020, 51(2): 542-548. doi: 10.1161/STROKEAHA.119.027225 pmid: 31842706
[34]	Kossorotoff M, Kerleroux B, Boulouis G, et al. Recanalization treatments for pediatric acute ischemic stroke in France[J]. JAMA Netw Open, 2022, 5(9): e2231343.
[35]	Dicpinigaitis AJ, Shapiro SD, Nuoman R, et al. Intravenous thrombolysis for treatment of pediatric acute ischemic stroke: Analysis of 20 years of population-level data in the United States[J]. Int J Stroke, 2023, 18(5): 555-561.
[36]	Rivkin MJ, Bernard TJ, Dowling MM, et al. Guidelines for Urgent Management of Stroke in Children[J]. Pediatr Neurol, 2016, 56: 8-17. doi: S0887-8994(15)30079-5 pmid: 26969237
[37]	Mackay MT, Yock-Corrales A, Churilov L, et al. Differentiating childhood stroke from mimics in the emergency department[J]. Stroke, 2016, 47(10): 2476-2481. doi: 10.1161/STROKEAHA.116.014179 pmid: 27601378
[38]	Lehman LL, Beslow LA, Steinlin M, et al. What will improve pediatric acute stroke care?[J]. Stroke, 2019, 50(2): 249-256. doi: 10.1161/STROKEAHA.118.022881 pmid: 30661501
[39]	Mackay MT, Yock-Corrales A, Churilov L, et al. Accuracy and reliability of stroke diagnosis in the pediatric emergency department[J]. Stroke, 2017, 48(5): 1198-1202. doi: 10.1161/STROKEAHA.116.015571 pmid: 28336681
[40]	Daverio M, Bressan S, Gregori D, et al. Patient and process factors associated with type of first neuroimaging and delayed diagnosis in childhood arterial ischemic stroke[J]. Acad Emerg Med, 2016, 23(9): 1040-1047. doi: 10.1111/acem.13001 pmid: 27155309
[41]	Medley TL, Miteff C, Andrews I, et al. Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke[J]. Int J Stroke. 2019 Jan;14(1):94-106.
[42]	Bivard A, Zhao H, Churilov L, et al. Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial[J]. Lancet Neurol, 2022, 21(6): 520-527. doi: 10.1016/S1474-4422(22)00171-5 pmid: 35525251

Progress of intravenous thrombolysis in pediatric acute ischemic stroke

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