Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management

Kristin P. Guilliams, Fenella J. Kirkham, Susanne Holzhauer, Steven Pavlakis, Bryan Philbrook, Catherine Amlie-Lefond, Michael J. Noetzel, Nomazulu Dlamini, Mukta Sharma, Jessica L. Carpenter, Christine K. Fox, Marcela Torres, Rebecca N. Ichord, Lori C. Jordan, Michael M Dowling

Research output: Contribution to journalArticle

Abstract

Background and Purpose- Sickle cell disease (SCD) and arteriopathy are pediatric stroke risk factors that are not mutually exclusive. The relative contributions of sickled red blood cells and arteriopathy to stroke risk are unknown, resulting in unclear guidelines for primary and secondary stroke prevention when both risk factors are present. We hypothesized that despite similarities in clinical presentation and radiographic appearance of arteriopathies, stroke evaluation and management differ in children with SCD compared with those without SCD. Methods- We compared presentation and management of children with and without SCD enrolled in the IPSS (International Pediatric Stroke Study) with acute arterial ischemic stroke, according to SCD and arteriopathy status. Regression modeling determined relative contribution of SCD and arteriopathy in variables with significant frequency differences. Results- Among 930 childhood arterial ischemic strokes, there were 98 children with SCD, 67 of whom had arteriopathy, and 466 without SCD, 392 of whom had arteriopathy. Arteriopathy, regardless of SCD status, increased likelihood of hemiparesis (odds ratio [OR], 1.94; 95% CI, 1.46-2.56) and speech abnormalities (OR, 1.67; 95% CI, 1.29-2.19). Arteriopathy also increased likelihood of headache but only among those without SCD (OR, 1.89; 95% CI, 1.40-2.55). Echocardiograms were less frequently obtained in children with SCD (OR, 0.58; 95% CI, 0.37-0.93), but the frequency of identified cardiac abnormalities was similar in both groups ( P=0.57). Children with SCD were less likely to receive antithrombotic therapy, even in the presence of arteriopathy (OR, 0.14; 95% CI, 0.08-0.22). Arteriopathy was associated with a significantly higher likelihood of antithrombotic therapy in children without SCD (OR, 5.36; 95% CI, 3.55-8.09). Conclusions- Arteriopathy, and not SCD status, was most influential of stroke presentation. However, SCD status influenced stroke management because children with SCD were less likely to have echocardiograms or receive antithrombotic therapy. Further work is needed to determine whether management differences are warranted.

Original languageEnglish (US)
Pages (from-to)1089-1094
Number of pages6
JournalStroke
Volume50
Issue number5
DOIs
StatePublished - May 1 2019

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Sickle Cell Anemia
Stroke
Pediatrics
Odds Ratio
Paresis
Secondary Prevention
Headache

Keywords

  • aspirin
  • child
  • headache
  • heparin
  • risk factor

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Guilliams, K. P., Kirkham, F. J., Holzhauer, S., Pavlakis, S., Philbrook, B., Amlie-Lefond, C., ... Dowling, M. M. (2019). Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management. Stroke, 50(5), 1089-1094. https://doi.org/10.1161/STROKEAHA.118.022800

Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management. / Guilliams, Kristin P.; Kirkham, Fenella J.; Holzhauer, Susanne; Pavlakis, Steven; Philbrook, Bryan; Amlie-Lefond, Catherine; Noetzel, Michael J.; Dlamini, Nomazulu; Sharma, Mukta; Carpenter, Jessica L.; Fox, Christine K.; Torres, Marcela; Ichord, Rebecca N.; Jordan, Lori C.; Dowling, Michael M.

In: Stroke, Vol. 50, No. 5, 01.05.2019, p. 1089-1094.

Research output: Contribution to journalArticle

Guilliams, KP, Kirkham, FJ, Holzhauer, S, Pavlakis, S, Philbrook, B, Amlie-Lefond, C, Noetzel, MJ, Dlamini, N, Sharma, M, Carpenter, JL, Fox, CK, Torres, M, Ichord, RN, Jordan, LC & Dowling, MM 2019, 'Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management', Stroke, vol. 50, no. 5, pp. 1089-1094. https://doi.org/10.1161/STROKEAHA.118.022800
Guilliams KP, Kirkham FJ, Holzhauer S, Pavlakis S, Philbrook B, Amlie-Lefond C et al. Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management. Stroke. 2019 May 1;50(5):1089-1094. https://doi.org/10.1161/STROKEAHA.118.022800
Guilliams, Kristin P. ; Kirkham, Fenella J. ; Holzhauer, Susanne ; Pavlakis, Steven ; Philbrook, Bryan ; Amlie-Lefond, Catherine ; Noetzel, Michael J. ; Dlamini, Nomazulu ; Sharma, Mukta ; Carpenter, Jessica L. ; Fox, Christine K. ; Torres, Marcela ; Ichord, Rebecca N. ; Jordan, Lori C. ; Dowling, Michael M. / Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management. In: Stroke. 2019 ; Vol. 50, No. 5. pp. 1089-1094.
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abstract = "Background and Purpose- Sickle cell disease (SCD) and arteriopathy are pediatric stroke risk factors that are not mutually exclusive. The relative contributions of sickled red blood cells and arteriopathy to stroke risk are unknown, resulting in unclear guidelines for primary and secondary stroke prevention when both risk factors are present. We hypothesized that despite similarities in clinical presentation and radiographic appearance of arteriopathies, stroke evaluation and management differ in children with SCD compared with those without SCD. Methods- We compared presentation and management of children with and without SCD enrolled in the IPSS (International Pediatric Stroke Study) with acute arterial ischemic stroke, according to SCD and arteriopathy status. Regression modeling determined relative contribution of SCD and arteriopathy in variables with significant frequency differences. Results- Among 930 childhood arterial ischemic strokes, there were 98 children with SCD, 67 of whom had arteriopathy, and 466 without SCD, 392 of whom had arteriopathy. Arteriopathy, regardless of SCD status, increased likelihood of hemiparesis (odds ratio [OR], 1.94; 95{\%} CI, 1.46-2.56) and speech abnormalities (OR, 1.67; 95{\%} CI, 1.29-2.19). Arteriopathy also increased likelihood of headache but only among those without SCD (OR, 1.89; 95{\%} CI, 1.40-2.55). Echocardiograms were less frequently obtained in children with SCD (OR, 0.58; 95{\%} CI, 0.37-0.93), but the frequency of identified cardiac abnormalities was similar in both groups ( P=0.57). Children with SCD were less likely to receive antithrombotic therapy, even in the presence of arteriopathy (OR, 0.14; 95{\%} CI, 0.08-0.22). Arteriopathy was associated with a significantly higher likelihood of antithrombotic therapy in children without SCD (OR, 5.36; 95{\%} CI, 3.55-8.09). Conclusions- Arteriopathy, and not SCD status, was most influential of stroke presentation. However, SCD status influenced stroke management because children with SCD were less likely to have echocardiograms or receive antithrombotic therapy. Further work is needed to determine whether management differences are warranted.",
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T1 - Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management

AU - Guilliams, Kristin P.

AU - Kirkham, Fenella J.

AU - Holzhauer, Susanne

AU - Pavlakis, Steven

AU - Philbrook, Bryan

AU - Amlie-Lefond, Catherine

AU - Noetzel, Michael J.

AU - Dlamini, Nomazulu

AU - Sharma, Mukta

AU - Carpenter, Jessica L.

AU - Fox, Christine K.

AU - Torres, Marcela

AU - Ichord, Rebecca N.

AU - Jordan, Lori C.

AU - Dowling, Michael M

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background and Purpose- Sickle cell disease (SCD) and arteriopathy are pediatric stroke risk factors that are not mutually exclusive. The relative contributions of sickled red blood cells and arteriopathy to stroke risk are unknown, resulting in unclear guidelines for primary and secondary stroke prevention when both risk factors are present. We hypothesized that despite similarities in clinical presentation and radiographic appearance of arteriopathies, stroke evaluation and management differ in children with SCD compared with those without SCD. Methods- We compared presentation and management of children with and without SCD enrolled in the IPSS (International Pediatric Stroke Study) with acute arterial ischemic stroke, according to SCD and arteriopathy status. Regression modeling determined relative contribution of SCD and arteriopathy in variables with significant frequency differences. Results- Among 930 childhood arterial ischemic strokes, there were 98 children with SCD, 67 of whom had arteriopathy, and 466 without SCD, 392 of whom had arteriopathy. Arteriopathy, regardless of SCD status, increased likelihood of hemiparesis (odds ratio [OR], 1.94; 95% CI, 1.46-2.56) and speech abnormalities (OR, 1.67; 95% CI, 1.29-2.19). Arteriopathy also increased likelihood of headache but only among those without SCD (OR, 1.89; 95% CI, 1.40-2.55). Echocardiograms were less frequently obtained in children with SCD (OR, 0.58; 95% CI, 0.37-0.93), but the frequency of identified cardiac abnormalities was similar in both groups ( P=0.57). Children with SCD were less likely to receive antithrombotic therapy, even in the presence of arteriopathy (OR, 0.14; 95% CI, 0.08-0.22). Arteriopathy was associated with a significantly higher likelihood of antithrombotic therapy in children without SCD (OR, 5.36; 95% CI, 3.55-8.09). Conclusions- Arteriopathy, and not SCD status, was most influential of stroke presentation. However, SCD status influenced stroke management because children with SCD were less likely to have echocardiograms or receive antithrombotic therapy. Further work is needed to determine whether management differences are warranted.

AB - Background and Purpose- Sickle cell disease (SCD) and arteriopathy are pediatric stroke risk factors that are not mutually exclusive. The relative contributions of sickled red blood cells and arteriopathy to stroke risk are unknown, resulting in unclear guidelines for primary and secondary stroke prevention when both risk factors are present. We hypothesized that despite similarities in clinical presentation and radiographic appearance of arteriopathies, stroke evaluation and management differ in children with SCD compared with those without SCD. Methods- We compared presentation and management of children with and without SCD enrolled in the IPSS (International Pediatric Stroke Study) with acute arterial ischemic stroke, according to SCD and arteriopathy status. Regression modeling determined relative contribution of SCD and arteriopathy in variables with significant frequency differences. Results- Among 930 childhood arterial ischemic strokes, there were 98 children with SCD, 67 of whom had arteriopathy, and 466 without SCD, 392 of whom had arteriopathy. Arteriopathy, regardless of SCD status, increased likelihood of hemiparesis (odds ratio [OR], 1.94; 95% CI, 1.46-2.56) and speech abnormalities (OR, 1.67; 95% CI, 1.29-2.19). Arteriopathy also increased likelihood of headache but only among those without SCD (OR, 1.89; 95% CI, 1.40-2.55). Echocardiograms were less frequently obtained in children with SCD (OR, 0.58; 95% CI, 0.37-0.93), but the frequency of identified cardiac abnormalities was similar in both groups ( P=0.57). Children with SCD were less likely to receive antithrombotic therapy, even in the presence of arteriopathy (OR, 0.14; 95% CI, 0.08-0.22). Arteriopathy was associated with a significantly higher likelihood of antithrombotic therapy in children without SCD (OR, 5.36; 95% CI, 3.55-8.09). Conclusions- Arteriopathy, and not SCD status, was most influential of stroke presentation. However, SCD status influenced stroke management because children with SCD were less likely to have echocardiograms or receive antithrombotic therapy. Further work is needed to determine whether management differences are warranted.

KW - aspirin

KW - child

KW - headache

KW - heparin

KW - risk factor

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