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Risk Factors for Postprocedural Arterial Ischemic Stroke in Children With Cardiac Disease
Bettina C Henzi1,2, Barbara Brotschi3, Christian Balmer4
1Division of Child Neurology, Department of Pediatrics, University Children's Hospital Bern, University of Bern, Switzerland (B.C.H., M.R., M.S.).
Insights
Cardiac interventions in children can lead to arterial ischemic stroke (AIS). Key risk factors include hypotension, prosthetic materials, shunts, arrhythmias, low cardiac output, and infections, highlighting the need for prompt diagnosis and management.
Area of Science:
- Pediatric Neurology
- Cardiology
- Stroke Research
Background:
- Cardiac pathologies are a significant risk factor for arterial ischemic stroke (AIS) in children.
- Understanding these risk factors is crucial for preventing and managing pediatric stroke.
Purpose of the Study:
- To analyze risk factors (RFs) for arterial ischemic stroke (AIS) in pediatric patients with cardiac disease.
- To investigate risk factors specifically in children who underwent cardiac intervention.
Main Methods:
- Data were extracted from the Swiss Neuropediatric Stroke Registry (2000-2015).
- Patients with cardiac disease and postprocedural AIS were analyzed for cardiac causes and potential risk factors.
Main Results:
- Out of 78 children with cardiac disease, 47 had cardiac interventions, with 36 experiencing postprocedural AIS.
- Median time from intervention to symptom onset was 4 days; diagnosis of AIS was delayed (median 2 days).
- Identified risk factors included hypotension, prosthetic cardiac material, right-to-left shunt, arrhythmias, low cardiac output, and infections.
Conclusions:
- Diagnosis of postprocedural AIS in children is often delayed.
- Multiple, potentially modifiable risk factors, such as hemodynamic alterations and infections, are prevalent in these cases.
Background And Purpose:
Cardiac pathologies are the second most frequent risk factor (RF) in children with arterial ischemic stroke (AIS). This study aimed to analyze RFs for AIS in children with cardiac disease and cardiac intervention.
Methods:
Data were drawn from the Swiss Neuropediatric Stroke Registry. Patients with cardiac disease and postprocedural AIS registered from 2000 until 2015 were analyzed for the cause of cardiac disease and for potential RFs.
Results:
Forty-seven out of 78 children with cardiac disease had a cardiac intervention. Of these, 36 presented a postprocedural AIS. Median time from cardiac intervention to symptom onset was 4 days (interquartile range, 2-8.5); time to diagnosis of AIS was 2 days (interquartile range, 0-5.8). Main RFs for postprocedural AIS were hypotension, prosthetic cardiac material, right-to-left shunt, arrhythmias, low cardiac output, and infections.
Conclusions:
In children with postprocedural AIS, time to diagnosis was delayed. Most patients presented multiple potentially modifiable RFs as hemodynamic alterations and infections.
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