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Stroke recurrence in children with congenital heart disease

Lance Rodan1, Brian W McCrindle, Cedric Manlhiot

  • 1Division of Neurology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Canada.

Annals of Neurology
|July 26, 2012
PubMed

Insights

Stroke recurrence is common in children with congenital heart disease (CHD), with 27% experiencing recurrence within 10 years. Identifying high-risk patients is crucial for targeted secondary prevention strategies.

Area of Science:

  • Pediatric Neurology
  • Cardiology
  • Stroke Medicine

Background:

  • Pediatric arterial ischemic stroke (AIS) is a significant cause of disability and death in children.
  • Congenital heart disease (CHD) is a primary risk factor for AIS in pediatric populations.
  • Limited data exist on stroke recurrence rates in children with CHD, hindering effective secondary prevention strategies.

Purpose of the Study:

  • To investigate the incidence and risk factors for stroke recurrence in children diagnosed with AIS and CHD.
  • To inform optimal secondary prophylaxis strategies for this vulnerable patient group.

Main Methods:

  • A retrospective analysis of the Canadian Pediatric Ischemic Stroke Registry-Toronto site (1992-2008).
  • Inclusion of children aged 0-18 years with CHD and AIS.
  • Parametric modeling using competing risk analysis to assess time-dependent outcomes (death, recurrent stroke) and survival models to identify recurrence predictors.

Main Results:

  • 135 patients with CHD and AIS were analyzed; 19 experienced stroke recurrence.
  • Within 10 years post-stroke, 27% had recurrent stroke, 26% died, and 47% were alive and recurrence-free.
  • Factors associated with recurrence included mechanical valves, prothrombotic conditions, and acute infection at the time of the initial stroke.

Conclusions:

  • Stroke recurrence is a significant concern in pediatric patients with CHD.
  • Specific patient groups, identified by factors like mechanical valves or infection, may benefit from intensified secondary prevention, particularly in the early post-stroke phase.
Abstract

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