Rates and Risk Factors for Arterial Ischemic Stroke Recurrence in Children

Stacey, Arthur; Toolis, Claire; Ganesan, Vijeya

doi:10.1161/strokeaha.117.020159

Cited by 23 publications

(28 citation statements)

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“…Future studies should seek to validate our findings in additional patient cohorts of children with a first onset of AIS with stroke subtypes clearly defined according to new paediatric stroke classifications like CASCADE. 39,40 Of note, our finding that recurrence of childhood AIS is comparable across European and North American centres supports the feasibility of multi-national recruitment strategies to sufficiently power randomized treatment studies, which could include the development of stroke recurrence prediction models. Such studies should be focused on prevention of recurrent stroke in sub-populations of paediatric patients with the highest risks for recurrent AIS.…”

Section: Discussionsupporting

confidence: 56%

Recurrent Stroke: The Role of Thrombophilia in a Large International Pediatric Stroke Population

deVeber

Kirkham²,

Shannon

et al. 2018

Blood

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Risk factors for arterial ischaemic stroke in children include vasculopathy and prothrombotic risk factors but their relative importance to recurrent stroke is uncertain. Data on recurrent stroke from the databases held in Canada (Toronto), Germany (Kiel-Lübeck/Münster), and UK (London/Southampton) were pooled. Data were available from 894 patients aged 1 month to 18 years at first stroke (median age 6 years) with a median follow-up of 35 months. 160/894 patients (17.9%) had recurrence from 1 day to 136 months after first stroke (median 3.1 months). Among 288 children with vasculopathy, recurrence was significantly more common (hazard ratio (HR) 2.5, 95% confidence intervals (CI) 1.92-3.5) compared to children without vasculopathy. Adjusting for vasculopathy, isolated antithrombin deficiency (HR 3.9; 95%CI 1.4-10.9), isolated elevated lipoprotein (a) (HR 2.3; 95%CI 1.3-4.1), and the presence of more than one prothrombotic risk (HR 1.9; 95%CI 1.12-3.2) were independently associated with an increased risk of recurrence. Recurrence rates calculated per 100 person-years were 10 (95%CI 3-24) for antithrombin deficiency, 6 (95%CI 4-9) for elevated lipoprotein (a), and 13 (95%CI 7-20) for the presence of more than one prothrombotic risk.Identifying children at increased for second stroke events is important in intensifying measures aimed at preventing recurrent stroke. Abstract: 199Main Text: 2630, 3 Figures, 3 Tables, 1 supplemental Figure

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Section: Discussionsupporting

confidence: 56%

Recurrent Stroke: The Role of Thrombophilia in a Large International Pediatric Stroke Population

deVeber

Kirkham²,

Shannon

et al. 2018

Blood

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“…A higher prevalence of recurrent stroke was noted by deVeber et al [29] and Sfaihi et al [37], namely 17.9% and 18% from 1 day to 136 months after the first stroke, respectively. In a group of 84 AIS children [38], the median interval to recurrence was 2.3 months and in most observed patients (77%), recurrence occurred within the first 6 months after stroke. Within 5 years of follow-up, AIS recurred in 13 pediatric patients (15.5%), whereas recurrence including TIA was present in 29% of patients (24 out of 84 children) [38].…”

Section: Prevalence Of Ais Recurrencementioning

confidence: 95%

“…In a group of 84 AIS children [38], the median interval to recurrence was 2.3 months and in most observed patients (77%), recurrence occurred within the first 6 months after stroke. Within 5 years of follow-up, AIS recurred in 13 pediatric patients (15.5%), whereas recurrence including TIA was present in 29% of patients (24 out of 84 children) [38].…”

Section: Prevalence Of Ais Recurrencementioning

confidence: 95%

“…In 2018, British authors from the Great Ormond Street Hospital, London, identified 84 AIS children (mostly girls, with a mean age at onset of 4.1 years); the cases were classified according to the CASCADE criteria and followed for a maximum of four years (mean follow-up period was 2.4 years) [38]. As for the CASCADE types, 3a and 3b were significantly associated with the risk of AIS recurrence within the analyzed group of children [38]. In a German study, 57 out of 86 AIS children enrolled between 2004 and 2017 met the criteria of arteriopathic stroke (1-4 CASCADE classification) [25].…”

Section: Arteriopathiesmentioning

confidence: 99%

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Risk Factors for Recurrent Arterial Ischemic Stroke in Children and Young Adults

Sarecka-Hujar

Kopyta

2020

Brain Sciences

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Arterial ischemic stroke (AIS) experienced at a young age is undoubtedly a serious medical problem. AIS very rarely occurs at a developmental age, whereas in young adults, it occurs with a higher frequency. The etiologic mechanisms of AIS occurring in childhood and adulthood differ. However, for both age populations, neurological consequences of AIS, including post-stroke seizures, motor disability, and recurrence of the disease, are connected to many years of care, rehabilitation, and treatment. Recurrent stroke was observed to increase the risk of patients’ mortality. One of the confirmed risk factors for recurrent stroke in children is the presence of vasculopathies, especially Moyamoya disease and syndrome, and focal cerebral arteriopathy of childhood (FCA). FCA causes a 5-fold increase in the risk of recurrent stroke in comparison with idiopathic AIS. In turn, young adults with recurrent stroke were found to more often suffer from hypertension, diabetes mellitus, or peripheral artery disease than young patients with first-ever stroke. Some reports also indicate relationships between specific genetic polymorphisms and AIS recurrence in both age groups. The aim of the present literature review was to discuss available data regarding the risk factors for recurrent AIS in children and young adults.

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“…Furthermore, we excluded patients with a history of CI or other CVD within 3 years prior to the index period, and patients with other causes of brain injury able to provoke the CI (e.g., brain trauma and brain tumor). Additionally, we excluded pediatric patients under 20 years of age, as the pathophysiology of pediatric CI is different from that of adult CI 12,15,32,43) .…”

Section: CImentioning

confidence: 99%

Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part II. Cerebral Infarction, Cerebral Arterial Stenosis, and Moyamoya Disease

Lee

Kim

Kwon

et al. 2020

J Korean Neurosurg Soc

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Objective : To analyze trends in the incidence and treatment of diseases associated with ischemic stroke, namely, cerebral infarction (CI), cerebral arterial stenosis (CASTN), and moyamoya disease (MMD), based on Korean National Health Insurance Service (NHIS) data from 2008 to 2016. Methods : Data was extracted from the national health-claim database provided by the NHIS for 2008-2016 using International Classification of Diseases codes. The crude and age-standardized incidences of each disease (CI, CASTN without a history of CI, and MMD) were calculated; additional analyses were conducted according to age and sex. Trends in the number of patients undergoing treatment according to treatment method were analyzed for each disease using the Korean Classification of Diseases procedure codes. Results : In 2016, the total number of adults with newly diagnosed CI was 83939, reflecting a 9.4% decrease from that in 2008. The agestandardized incidence of CI in adults was 153.2 per 100000 person-years in 2016, reflecting a 37.2% decrease from that in 2008, while that of CASTN was 167.3 per 100000 person-years in 2016, reflecting a 73.3% increase from that in 2008. Among treated cases, the number of patients who underwent intra-arterial (IA) treatment, including IA fibrinolysis and mechanical thrombectomy, showed the most prominent increase, increasing at an annual rate of 25.8%. For CASTN, the number of cases treated with carotid artery stenting or balloon angioplasty (CAS) showed the most prominent increase, increasing at a rate of 69.8% over the 9-year period. For MMD, the total number of patients with newly diagnosed MMD and that with adult MMD demonstrated significantly increasing trends, while the number of pediatric patients with newly diagnosed MMD declined by 18.0% over the 9-year period. The age-standardized incidences of pediatric and adult MMD in 2016 were 2.4 and 3.4 per 100000 person-years, respectively. Conclusion : Although the incidence of CI showed a declining trend over a 9-year period, the number and proportion of patients treated for CI increased. Meanwhile, the incidence of CASTN and the number of patients treated for CASTN have demonstrated increasing trends since 2008. On the other hand, the number of patients diagnosed with pediatric MMD decreased, despite no significant change in the incidence. In contrast, the number of patients and the incidence of adult MMD increased. These trends reflect changes in the population structure, gains in the accessibility of imaging examinations, and the development of endovascular techniques. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Rates and Risk Factors for Arterial Ischemic Stroke Recurrence in Children

Cited by 23 publications

References 20 publications

Recurrent Stroke: The Role of Thrombophilia in a Large International Pediatric Stroke Population

Recurrent Stroke: The Role of Thrombophilia in a Large International Pediatric Stroke Population

Risk Factors for Recurrent Arterial Ischemic Stroke in Children and Young Adults

Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part II. Cerebral Infarction, Cerebral Arterial Stenosis, and Moyamoya Disease

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