Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

International Pediatric Stroke Study Investigators

Research output: Contribution to journalArticle

Abstract

Objective: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. Methods: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Peri-procedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. Results: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P = 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P = 0.01) compared to those with peri-procedural AIS. Conclusions: Children with cardiac disease are at risk for AIS at the time of cardiac procedures but also outside of the immediate 72 hours after procedures. Many have acute systemic illness or thrombotic event preceding AIS, suggesting that inflammatory or prothrombotic conditions could act as a stroke trigger in this susceptible population.

Original languageEnglish (US)
JournalPediatric Neurology
DOIs
StatePublished - Jan 1 2019

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Heart Diseases
Stroke
Newborn Infant
Patent Foramen Ovale
Cardiac Catheterization
Thoracic Surgery
Registries
Pediatrics

Keywords

  • Cardiac disease
  • Cardiac procedure
  • Embolism
  • Pediatric arterial ischemic stroke
  • Pediatric stroke
  • Stroke

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children. / International Pediatric Stroke Study Investigators.

In: Pediatric Neurology, 01.01.2019.

Research output: Contribution to journalArticle

International Pediatric Stroke Study Investigators. / Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children. In: Pediatric Neurology. 2019.
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title = "Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children",
abstract = "Objective: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. Methods: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Peri-procedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. Results: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26{\%}) had peri-procedural AIS and 495 patients (74{\%}) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 {\%} versus 9 {\%}, P = 0.02) and to have a moderate or severe neurological deficit at discharge (67{\%} versus 33{\%}, P = 0.01) compared to those with peri-procedural AIS. Conclusions: Children with cardiac disease are at risk for AIS at the time of cardiac procedures but also outside of the immediate 72 hours after procedures. Many have acute systemic illness or thrombotic event preceding AIS, suggesting that inflammatory or prothrombotic conditions could act as a stroke trigger in this susceptible population.",
keywords = "Cardiac disease, Cardiac procedure, Embolism, Pediatric arterial ischemic stroke, Pediatric stroke, Stroke",
author = "{International Pediatric Stroke Study Investigators} and Chung, {Melissa G.} and Guilliams, {Kristin P.} and Wilson, {Jenny L.} and Beslow, {Lauren A.} and Dowling, {Michael M} and Friedman, {Neil R.} and Hassanein, {Sahar M.A.} and Rebecca Ichord and Jordan, {Lori C.} and Mackay, {Mark T.} and Rafay, {Mubeen F.} and Michael Rivkin and Marcela Torres and Dimitrios Zafeiriou and Gabrielle deVeber and Fox, {Christine K.}",
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AU - International Pediatric Stroke Study Investigators

AU - Chung, Melissa G.

AU - Guilliams, Kristin P.

AU - Wilson, Jenny L.

AU - Beslow, Lauren A.

AU - Dowling, Michael M

AU - Friedman, Neil R.

AU - Hassanein, Sahar M.A.

AU - Ichord, Rebecca

AU - Jordan, Lori C.

AU - Mackay, Mark T.

AU - Rafay, Mubeen F.

AU - Rivkin, Michael

AU - Torres, Marcela

AU - Zafeiriou, Dimitrios

AU - deVeber, Gabrielle

AU - Fox, Christine K.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. Methods: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Peri-procedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. Results: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P = 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P = 0.01) compared to those with peri-procedural AIS. Conclusions: Children with cardiac disease are at risk for AIS at the time of cardiac procedures but also outside of the immediate 72 hours after procedures. Many have acute systemic illness or thrombotic event preceding AIS, suggesting that inflammatory or prothrombotic conditions could act as a stroke trigger in this susceptible population.

AB - Objective: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. Methods: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Peri-procedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. Results: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P = 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P = 0.01) compared to those with peri-procedural AIS. Conclusions: Children with cardiac disease are at risk for AIS at the time of cardiac procedures but also outside of the immediate 72 hours after procedures. Many have acute systemic illness or thrombotic event preceding AIS, suggesting that inflammatory or prothrombotic conditions could act as a stroke trigger in this susceptible population.

KW - Cardiac disease

KW - Cardiac procedure

KW - Embolism

KW - Pediatric arterial ischemic stroke

KW - Pediatric stroke

KW - Stroke

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