Thrombectomy versus Medical Management for Pediatric Acute Ischemic Stroke Due to Isolated <scp>M2</scp> Occlusion: A Multicenter Cohort Study
Bibliographic record
Abstract
OBJECTIVE: Endovascular thrombectomy (EVT) is increasingly used for pediatric large vessel occlusion (LVO) stroke, however, its role in isolated M2 occlusions remains underexplored. This study compared clinical outcomes in children with isolated M2 occlusion treated with EVT versus best medical therapy (BMT). METHODS: This multicenter cohort study pooled data from 4 pediatric stroke registries (Save ChildS, KidClot, Pediatric LVO Study, and Save ChildS Pro). Children ages 28 days-17 years with isolated M2 occlusion presenting within 24 hours of last seen well were included. Primary outcome was the pediatric modified Rankin scale (ped-mRS) at 3 to 6 months. Secondary outcomes included changes in Pediatric National Institutes of Health Stroke Scale (PedNIHSS), Pediatric Stroke Outcome Measure (PSOM), and safety endpoints. RESULTS: Forty patients were included, of whom 20 were treated with EVT (median age, 12 years; interquartile range [IQR], 6-15; 40% female) and 20 with BMT only (10 years; IQR, 5-14; 50% female). Baseline demographics were similar. EVT patients showed superior outcomes: median ped-mRS at 3 to 6 months was 1 versus 2 (p = 0.015). EVT resulted in greater PedNIHSS reduction from admission to day 7 (-9 vs -1, p < 0.001) and lower PSOM at 3 to 6 months (0.5 vs 2.5, p = 0.009). This benefit persisted at 24 months with a median ped-mRS of 1 (IQR, 0-2) in the EVT group and 2 (IQR, 1-3) in the BMT group (p = 0.012). One symptomatic intracranial hemorrhage occurred in the BMT group, and no deaths or access-site complications were reported. INTERPRETATION: In children with isolated M2 occlusion, EVT was associated with better functional outcomes and neurological recovery than medical therapy alone, with an acceptable safety profile. ANN NEUROL 2026;99:684-691.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".