Risk of Recurrent Arterial Ischemic Stroke in Childhood

Abstract

Background and Purpose Published cohorts of children with arterial ischemic stroke (AIS) in the 1990s to early 2000s reported five-year cumulative recurrence rates approaching 20%. Since then, utilization of antithrombotic agents for secondary stroke prevention in children has increased. We sought to determine rates and predictors of recurrent stroke in the current era. Methods The Vascular effects of Infection in Pediatric Stroke (VIPS) study enrolled 355 children with AIS at 37 international centers from 2009–2014, and followed them prospectively for recurrent stroke. Index and recurrent strokes underwent central review and confirmation, as well as central classification of stroke etiologies, including arteriopathies. Other predictors were measured via parental interview or chart review. Results Of the 355 children, 354 survived their acute index stroke, and 308 (87%) were treated with an antithrombotic medication. During a median follow-up of 2.0 years (interquartile range, 1.0–3.0), 40 children had a recurrent AIS, and none had a hemorrhagic stroke. The cumulative stroke recurrence rate was 6.8% (95% CI 4.6–10%) at one month and 12% (8.5–15%) at one year. The sole predictor of recurrence was presence of an arteriopathy, which increased the risk of recurrence 5-fold compared to an idiopathic AIS (hazard ration 5.0, 95% CI 1.8–14). The one-year recurrence rate was 32% (95% CI 18–51%) for moyamoya, 25% (12–48%) for transient cerebral arteriopathy, and 19% (8.5–40%) for arterial dissection. Conclusions Children with AIS, particularly those with arteriopathy, remain at high risk for recurrent AIS despite increased utilization of antithrombotic agents. Therapies directed at the arteriopathies themselves are needed.

Inflammatory Biomarkers in Childhood Arterial Ischemic Stroke

“…Details of our methods for enrollment, case confirmation, data collection, classification of etiology, parental interview, sample collection, and ascertainment and confirmation of recurrent AIS are published. 2, 6–8, 17 In brief, a team of pediatric stroke neurologists and neuroradiologists confirmed cases after central review of imaging and clinical features. A single neuroradiologist (M.W.)…”

“…1 Presence of an arteriopathy (cervical or cerebral) confers an increased risk of recurrent AIS. 2–5 In the prospective, multicenter “Vascular effects of Infection in Pediatric Stroke” (VIPS) study, children with arteriopathic stroke had a 21% (95% CI, 14%–29%) chance of recurrence within 1 year, compared to 8% (95% CI 3%–18%) with cardioembolic and 5% (95% CI, 2%–12%) with idiopathic stroke. 2 Childhood arteriopathies are themselves heterogeneous and poorly understood, 6 yet mounting evidence suggests that infection and inflammation play a role in their pathogenesis.…”

Stroke in children and adolescents: a formation of a pediatric register

“…В последние годы благодаря проведению вторичной профилактики ИИ с помощью современных антитромбо-тических средств средний кумулятивный риск повторного ИИ в детском возрасте удалось снизить до 6,8% случаев в течение 1-го месяца и 12% в течение 1-го года после пер-вого ИИ [17]. При этом повторные ИИ значительно чаще развивались в течение года при болезни моямоя (32%), транзиторной церебральной артериопатии (25%) и арте-риальной диссекции (19%) [17].…”

“…При этом повторные ИИ значительно чаще развивались в течение года при болезни моямоя (32%), транзиторной церебральной артериопатии (25%) и арте-риальной диссекции (19%) [17].…”

“…Кроме того, у значитель-ного числа пациентов после ИИ наблюдались эпилепти-ческие приступы (9 человек) и частые головные боли (17). Данные клинические особенности отличали обследован-ную группу детей и подростков от перенесших инсульт взрослых пациентов.…”