14 ISC NEWS DAY 1 | WEDNESDAY, FEBRUARY 5, 2025 StrokeConference.org #ISC25 management of stroke in neonates and children, a comprehensive guide for clinical practice that also highlights gaps in the literature and areas of focus for future studies. Also among Wednesday’s speakers discussing pediatric stroke is Peter Sporns, MD, MHBA, FESO, associate professor in diagnostic and interventional neuroradiology at University Hospital Basel in Switzerland. His presentation, “Endovascular Management of LVO in Pediatric Patients,” will detail the recent results of the Save ChildS Pro study. This prospective, multicenter registry study follows children with arterial ischemic stroke caused by large vessel occlusion who underwent endovascular thrombectomy. “These children had significantly better outcomes than children who received best medical therapy only,” Sporns said. “This study shows that it is important to perform this interventional procedure in eligible children and that there are no major safety concerns.” The session will also delve into data from meta-analyses on endovascular interventions and discuss age limits for these procedures in neonates and infants. According to Sporns, there is no reliable meta-analysis on the age question; the best available data come from the Save ChildS Pro registry. Many neurointerventionalists would agree that in children 6 years and older, endovascular management is feasible and safe in the hands of providers who are experienced in treating children, Sporns said. “Below this age, endovascular management of children with stroke may potentially improve outcomes in selected children, but this is not as wellinvestigated, especially for neonates. It’s very controversial due to different underlying etiologies.” Overall, Pearson noted that to improve pediatric stroke outcomes, focusing on child-specific challenges is key. “Most of these challenges boil down to the fact that children are not ‘little adults.’ Common etiologies and types of strokes differ in pediatrics compared to the adult population. Stroke recovery can look different in a developing brain, and stroke mimics are more common than true stroke in children,” she said. “We must recognize these nuances and be thoughtful in how and when we extrapolate adult stroke therapies to the pediatric population to ensure we are doing the best thing for our patients.” Methodologies in Stroke Trials,” will explore how neurologists can rethink the consent process to meet the challenges of acute stroke trials. Traditional informed consent approaches are impractical because of the critical time window in stroke research. Alternatives such as deferred consent, waiver of consent and advance consent models prioritize ethical integrity while addressing logistical realities, Singh said. These innovations can streamline trial operations, improve recruitment and maintain ethical rigor, she said. Recruiting larger, more diverse study populations is another key challenge. Historically, RCTs have excluded groups including women, the elderly and patients from underrepresented regions, which limits the applicability of findings on a global scale. And conducting large-scale, multinational trials is increasingly expensive, with regulatory hurdles, site training and data harmonization adding to the logistical burden. “As we tackle these challenges, it’s clear that traditional models must adapt to stay relevant,” Singh said. Several promising solutions are on the horizon, Singh said. For example, adaptive trial designs allow researchers to make real-time adjustments based on interim results, such as modifying sample sizes or adding treatment arms. This flexibility accelerates timelines and reduces costs, she said. Technology is another game-changer. “The use of telemedicine for remote recruitment and follow-ups has proven invaluable, especially in the wake of the pandemic,” Singh said. “Additionally, AI-driven data analytics can help us predict patient outcomes and stratify treatments more effectively.” There are other innovative solutions, according to Tolulope Sajobi, PhD, a professor of biostatistics at the University of Calgary Cumming School of Medicine in Alberta. These include integrating wearable devices for long-term and rich data collection (global harmonization and standardization of data); linking multiple data sources (such as electronic health records, registries and omics data); and leveraging digital health platforms for enrollment and outcome assessment. Investing in modern data infrastructures that ensure flexible outcome assessment and data management is critical — and costeffective — for generating robust evidence about the efficacy and effectiveness of interventions, said Sajobi, whose presentation Wednesday is titled “Modernizing Data Infrastructure for Large Global Trials.” “Prioritizing patient-centered data collection and infrastructures that simplify outcomes assessment while providing participants with flexibility to complete their outcomes from anywhere in the world will improve the inclusivity of trials,” he said. In addition, engaging patients in the design phase of trials can ensure that protocols are relevant and feasible, Singh and Sajobi said. “By embracing these innovations, we can make stroke trials more efficient, inclusive and impactful, ultimately improving care on a global scale,” Sajobi said. PEDIATRIC continued from page 3 MODERNIZING continued from page 1 The American Stroke Association is grateful for the continued support and generosity of our exhibitors and sponsors. We want to recognize the following companies for their additional sponsorship and advertising opportunities. • AstraZeneca • BMS/Janssen Alliance • Boston Scientific • Chiesi • Encompass Health • Johnson & Johnson MedTech • Medscape • Medtronic • MicroTransponder, Inc. • National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Neurological Disorders and Stroke (NINDS) • NeuraSignal • Neurologica • RapidAI • Sevaro • TeleSpecialists • Terumo Neuro • Total CME • Vituity • VoxMedia • Wolters Kluwer Educational grant support provided by: • Boston Scientific Corporation • Chiesi USA, Inc. • DePuy Synthes Products, Inc., d/b/a Cerenovus Sajobi “We must recognize these nuances and be thoughtful in how and when we extrapolate adult stroke therapies to the pediatric population to ensure we are doing the best thing for our patients.” –Rachel Pearson, MD
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