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Published on: April 21, 2017
Arterial ischemic stroke in children with congenital heart diseases
Hye-Ryun Yeh1, Eun-Hee Kim2, Jeong-Jin Yu3
1Department of Pediatrics, Seoul Medical Center, Seoul, Korea.
Insights
Children with congenital heart disease (CHD) and arterial ischemic stroke (AIS) often have additional risk factors. Middle cerebral artery involvement and hemorrhagic transformation predict poor outcomes in pediatric AIS patients with CHD.
Area of Science:
- Pediatric Neurology
- Cardiology
- Stroke Research
Background:
- Congenital heart disease (CHD) is a significant risk factor for arterial ischemic stroke (AIS) in children.
- Understanding the prevalence, risk factors, and outcomes of AIS in pediatric CHD patients is crucial for improving care.
Purpose of the Study:
- To investigate the prevalence of thromboembolic risk factors and neurologic outcomes in children diagnosed with both congenital heart disease and arterial ischemic stroke.
- To identify predictors of unfavorable outcomes in this vulnerable pediatric population.
Main Methods:
- Retrospective analysis of clinical data from children with CHD and AIS between 2000 and 2016.
- Evaluation of demographics, procedural data, neuroimaging, antithrombotic treatments, and neurological status at follow-up.
Main Results:
- Cyanotic CHD was prevalent in 24 of 30 AIS cases; 70% of AIS events were procedure-related.
- Additional thromboembolic causes were present in 46.7% of patients; 10% experienced recurrent AIS, and 20% developed post-stroke epilepsy.
- Unfavorable outcomes (including death) occurred in 43.3%, significantly associated with middle cerebral artery main branch involvement and hemorrhagic transformation.
Conclusions:
- Thromboembolic risk factors, including cardiac thrombus, arrhythmias, and surgical procedures, are common in pediatric AIS patients with CHD.
- Main branch middle cerebral artery involvement and hemorrhagic transformation are key predictors of poor neurologic outcomes.
- Further research is needed to develop targeted stroke prevention and prophylactic strategies for children with CHD.
Background:
We describe the prevalence, thromboembolic risk factors, and neurologic outcomes in children with congenital heart disease (CHD) and arterial ischemic stroke (AIS).
Methods:
We retrospectively analyzed the clinical data of children with CHD and AIS from 2000 to 2016. Demographics, procedural and postprocedural data, neuroimaging findings, details of antithrombotic treatment, and neurological status at last follow up were evaluated.
Results:
Patients with cyanotic CHD accounted for 24 of 30 cases with AIS. The majority of AIS (70%) was procedure related, and the mean time from procedure to diagnosis of stroke was 9.7 (range, 1-30) days. At the time of AIS, 14 (46.7%) patients revealed coexistence of additional thromboembolic causes of AIS. Three patients (10.0%) experienced recurrent AIS and six patients (20.0%) were diagnosed with post-stroke epilepsy. The unfavorable outcomes were found in 13 patients (43.3%), including four deaths. The unfavorable outcome was significantly associated with the main branch involvement of middle cerebral artery (OR = 10.296, 95% CI = 1.335-79.439) and hemorrhagic transformation (OR = 16.264, 95% CI = 1.359-194.690).
Conclusions:
Additional thromboembolic risk factors such as systemic or cardiac thrombus, arrhythmia, and surgical procedures for cyanotic CHD were found in patients with CHD and AIS. The main branch involvement of middle cerebral artery and hemorrhagic transformation were significant predictors of unfavorable outcomes. Further studies are required to identify the target for stroke prevention and develop better prophylactic strategies to minimize AIS in patients with CHD.
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