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Risk of Recurrent Arterial Ischemic Stroke in Childhood: A Prospective International Study

Heather J Fullerton1, Max Wintermark2, Nancy K Hills2

  • 1From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B), University of California, San Francisco; Department of Radiology, Stanford University, Palo Alto, CA (M.W.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Departments of Pediatrics and Neurosciences, University of the Philippines-Philippine General Hospital, Manila, Philippines (M.T.); Section of Neurology, Children's Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (M.F.R.); Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (M.S.V.E.); Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.V.). heather.fullerton@ucsf.edu.

Stroke
|November 12, 2015
PubMed

Insights

Children with arterial ischemic stroke (AIS) face a significant risk of recurrence, with 1-year rates reaching 12%. Arteriopathy is the primary predictor, highlighting the need for targeted therapies beyond antithrombotic agents.

Area of Science:

  • Pediatric Neurology
  • Vascular Neurology
  • Pediatric Stroke Research

Background:

  • Historical 5-year recurrence rates for pediatric arterial ischemic stroke (AIS) approached 20% in the 1990s-2000s.
  • Increased use of antithrombotic agents for secondary stroke prevention in children has occurred since then.

Purpose of the Study:

  • To determine current rates of recurrent AIS in children.
  • To identify predictors of recurrent stroke in the current era of increased antithrombotic use.

Main Methods:

  • Prospective enrollment of 355 children with AIS in the Vascular Effects of Infection in Pediatric Stroke (VIPS) study (2009-2014).
  • Central review of index and recurrent strokes, including cause classification (arteriopathies).
  • Prospective follow-up for recurrent stroke events.

Main Results:

  • The 1-year cumulative stroke recurrence rate was 12% (95% CI, 8.5%-15%).
  • Arteriopathy was the sole predictor of recurrence, increasing risk 5-fold (HR, 5.0; 95% CI, 1.8-14).
  • Specific arteriopathies like moyamoya showed high 1-year recurrence rates (32%).

Conclusions:

  • Children with AIS, especially those with arteriopathy, remain at high risk for recurrence despite antithrombotic therapy.
  • Novel therapies targeting the underlying arteriopathies are necessary for effective secondary prevention.
Abstract

Keywords:
childpediatricsrisk factorstrokevaccination

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