{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:46:09Z","timestamp":1791899169283,"version":"4.3.4"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Thrombolysis is infrequently delivered to children with acute ischemic strokes (AIS). We explored potential eligibility for treatment with tPA (tissue-type plasminogen activator) for pediatric AIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This retrospective, multicenter, observational, cohort study reviewed children aged 29 days to 17 years with symptomatic AIS identified via Children\u2019s Hospital Westmead, John Hunter Children\u2019s Hospital, and Sydney Children\u2019s Hospital between January 1, 2010, and December 31, 2019. Medical records were examined to evaluate eligibility for treatment with tPA based on established multinational and the 2026 American Heart Association guidelines, reasons for exclusion beyond delay to diagnosis, and long-term outcomes as pediatric modified Rankin Scale scores. We also explored additional exclusions and outcomes among children with small-vessel AIS and AIS in the context of brain tumors, who are currently excluded from tPA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>A total of 135 patients with 139 symptomatic AIS were identified\u2014median age, 6 years; 36% female patients; 73% presented via emergency departments; mean follow-up, 43 months; 12% deaths. Irrespective of delay to diagnosis, only 26 of 139 (19%) AIS were potentially eligible for treatment with tPA. Among patients potentially eligible for tPA, acute neuroimaging revealed large-vessel occlusions, unilateral focal cerebral arteriopathy, or extracranial dissections. Thirteen of 26 (50%) had nondisabled outcomes without tPA treatment. One hundred thirteen of 139 (81%) AIS were ineligible for treatment with tPA, irrespective of delay to diagnosis. All deaths occurred among patients excluded from tPA, predominantly related to underlying disorders. Fifty-four small-vessel AIS accounted for 39% of AIS. Eighteen (33%) had no additional ineligibilities to thrombolysis, among whom 10 had nondisabled outcomes without tPA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Based on current recommendations, 19% of symptomatic childhood AIS were potentially eligible for treatment with tPA, irrespective of delay to diagnosis. Selected patients with small-vessel AIS may offer an opportunity to extend the role of tPA. These observations may be relevant for optimizing pediatric stroke management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.054223","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:01:55Z","timestamp":1787821315000},"page":"3000-3009","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Eligibility for Thrombolysis for Pediatric Acute Ischemic Stroke"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1726-2402","authenticated-orcid":true,"given":"Romain C.","family":"Briest","sequence":"first","affiliation":[{"name":"Department of Neurology, Sydney Children\u2019s Hospital, Randwick, New South Wales, Australia (R.C.B., A.M.B., M.C., D.L.C., M.A.F., A.J., T.K., J.L., S.C.P., H.S., H.L.T., P.I.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3431-5647","authenticated-orcid":true,"given":"Kartik D.","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Children\u2019s Hospital at Westmead, New South Wales, Australia (K.D.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1808-5534","authenticated-orcid":true,"given":"Christina","family":"Miteff","sequence":"additional","affiliation":[{"name":"Department of Neurology, John Hunter Children\u2019s Hospital, Newcastle, New South Wales, Australia (C.M., F.M., R.L.S., G.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-9198","authenticated-orcid":true,"given":"Andrew","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Neurointervention, Prince of Wales Hospital, Randwick, New South Wales, Australia (A.C., N.W.M., A.M., J. Wenderoth, J. Whitley)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayne","family":"Antony","sequence":"additional","affiliation":[{"name":"T.Y. Nelson Department of Neurology and Neurosurgery, Children\u2019s Hospital at Westmead, Westmead and University of Sydney, New South Wales, Australia (J.A., S.A.-H., R.C.D., D.G., S.G., M.P.M., C.T., R.I.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Ardern-Holmes","sequence":"additional","affiliation":[{"name":"T.Y. Nelson Department of Neurology and Neurosurgery, Children\u2019s Hospital at Westmead, Westmead and University of Sydney, New South Wales, Australia (J.A., S.A.-H., R.C.D., D.G., S.G., M.P.M., C.T., R.I.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann M.","family":"Bye","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sydney Children\u2019s Hospital, Randwick, New South Wales, Australia (R.C.B., A.M.B., M.C., D.L.C., M.A.F., A.J., T.K., J.L., S.C.P., H.S., H.L.T., P.I.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2961-4594","authenticated-orcid":true,"given":"Michael","family":"Cardamone","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sydney Children\u2019s Hospital, Randwick, New South Wales, Australia (R.C.B., A.M.B., M.C., D.L.C., M.A.F., A.J., T.K., J.L., S.C.P., H.S., H.L.T., P.I.A.)."},{"name":"Discipline of Paediatrics and Child Health, Randwick Clinical Campus, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia (A.B., M.C., D.L.C., M.F., A.J., T.K., H.S., H.L.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7039-8400","authenticated-orcid":true,"given":"Denise L.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sydney Children\u2019s Hospital, Randwick, New South Wales, Australia (R.C.B., A.M.B., M.C., D.L.C., M.A.F., A.J., T.K., J.L., S.C.P., H.S., H.L.T., P.I.A.)."},{"name":"Discipline of Paediatrics and Child Health, Randwick Clinical Campus, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia (A.B., M.C., D.L.C., M.F., A.J., T.K., H.S., H.L.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell C.","family":"Dale","sequence":"additional","affiliation":[{"name":"T.Y. Nelson Department of Neurology and Neurosurgery, Children\u2019s Hospital at Westmead, Westmead and University of Sydney, New South Wales, Australia (J.A., S.A.-H., R.C.D., D.G., S.G., M.P.M., C.T., R.I.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4472-0902","authenticated-orcid":true,"given":"Michelle A.","family":"Farrar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sydney Children\u2019s Hospital, Randwick, New South Wales, Australia (R.C.B., A.M.B., M.C., D.L.C., M.A.F., A.J., T.K., J.L., S.C.P., H.S., H.L.T., P.I.A.)."},{"name":"Discipline of Paediatrics and Child Health, Randwick Clinical Campus, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia (A.B., M.C., D.L.C., M.F., A.J., T.K., H.S., H.L.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6219-9479","authenticated-orcid":true,"given":"Deepak","family":"Gill","sequence":"additional","affiliation":[{"name":"T.Y. 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