Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

Abstract

Objective: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. Methods: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Periprocedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. Results: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P ¼ 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P ¼ 0.01) compared to those with peri-procedural AIS.

Childhood strokes in China describing clinical characteristics, risk factors and performance indicators: a case-series study

“… 13 In children presenting with posterior circulations strokes, dissection of the vertebral artery should always be considered in the differential consideration. 14 Data from the IPSS showed that cardiac diseases are the primary cause of AIS, accounting for 28% 15 which was higher than our result (8.14%). PTSs were not found in our cases.…”

“…Mosch et al 35 demonstrated that children and adults matched for infarct site had similar levels of impairment. Pavlovic et al reported that up to two-thirds of patients experience lifelong neurological or cognitive sequelae 15 36. Hemiparesis is one of the most common long-term neurological consequences.…”

“…Data from the IPSS including more than 600 children who had an AIS reported residual impairments in 74% of them 38. Most studies estimate that over 50%–70% of patients who had a paediatric stroke will have long-lasting or persistent neurological deficits or develop subsequent cognitive, learning, seizure disorders or developmental problems 15 39…”

Neurodevelopmental and Mental Health Outcomes in Patients With Fontan Circulation: A State-of-the-Art Review

“…Among patients with CHD, the highest prevalence of stroke is in children with single ventricle; one preoperative study of neonates with HLHS found stroke in 7%, with the rate as high as 13% in a separate study of adolescents who were post-Fontan ( 27 , 48 ). About a quarter of strokes in children with CHD are associated with catheterization or other cardiac procedures ( 40 , 46 , 49 , 50 ). A multitude of factors likely contribute to thromboembolic risk during the periprocedural period including exposure to non-native materials, high hematocrit, inflammation, sluggish venous flow from high Glenn or Fontan pressures, and prolonged immobilization ( 42 , 51 ).…”

Assessment of Post-Stroke Consequences in Pediatric Ischemic Stroke in the Context of Neuroimaging Results—Experience from a Single Medical Center

“…The groups of risk factors for childhood stroke involve: cerebral arteriopathies, congenital and acquired heart diseases, congenital and acquired conditions conducive to thrombosis, as well as injuries and intoxications. Congenital heart defects and acquired cardiovascular diseases may be considered as independent causes of an AIS in children, while in 30% of children, secondary cerebral ischemia develops during procedures related to the treatment of these conditions [7]. AIS may also occur in children after cardiac catheterization [8].…”