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DOI: 10.1055/s-0038-1675944
FV 571. Cardiac Kids with Stroke
Publication History
Publication Date:
30 October 2018 (online)
Background: The etiology of ischemic stroke in children is multifactorial and few risk factors are modifiable. Cardiac pathologies are the second most frequent risk factor in children for developing arterial ischemic stroke (AIS).
Aims: The aim of this study was to analyze risk factors for AIS in children with cardiac disease and to advance diagnosis and treatment.
Question: What are the main risk factors for AIS in children with cardiac disease?
Methods: The Swiss Neuropediatric Stroke Registry (SNPSR) is a prospective population-based multicenter registry containing also data about all children residing in Switzerland with AIS. In this study, all children with AIS and cardiac disease from January 2000 until December 2015 were included. AIS was defined as focal neurologic deficit of acute onset confirmed by neuroimaging. Retrospectively, we analyzed the etiology of cardiac disease and interventional parameters. We dichotomized the cohort into patients with cardiac disease needing acute or subacute therapy (group A = 55) and patients not needing therapy of their cardiac disease prior to stroke or with patent foramen ovale (PFO) alone (group B = 16 and 18, respectively).
Results: Of the total of 436 children with acute AIS included in the SNPSR, 89 (20.4%) had additional cardiac disease and were included in this study. Median age at diagnosis of AIS in the children with cardiac disease was 5 months (interquartile range: 0–69.5). Seventy-eight (87.6%) had congenital heart disease of which 22 were cyanotic, 38 acyanotic, and 18 had a PFO alone. Eleven patients suffered either from acquired cardiac disease or the etiology was unclear. In group A, 47 had received a cardiosurgical procedure or a cardiac catheterization before AIS. Out of 47, 36 were within the last month, and 27 within the last week prior to AIS. The remaining eight patients had medical therapy alone.
In the whole cohort, mean time to diagnosis was 3.4 days (±6.7). In group A mean time to diagnosis was 4 days compared with 2.38 days in group B (p = 0.184). Mean stay in intensive care (comprising postinterventional stay) of group A was 24.44 days compared with 6.5 days in group B (p = 0.01).
The most frequent risk factor in group A was hypotension (49.1%) during intervention for more than 10 minutes, followed by low cardiac output (41.8%), infection (40%), arrhythmias (38.2%), and major complications during intervention or during ICU stay (36.4%). In group B, the most frequent risk factor was infection (23.5%) followed by puberty (20.6%). The total of 89 patients had an average of 6.7 risk factors; group A, a mean of 9.14 and group B, a mean of 2.7 risk factors per patient (p < 0.001).
Conclusion: In children with AIS and cardiac disease, time to diagnosis takes longer when stroke occurred in the setting of an acute cardiac intervention. Postoperative analgesia and sedation may mask neurological symptoms. Main risk factors for these children are hemodynamic alterations and infections. In view of possible interventions such as thrombectomy, children at high risk need careful bedside neurological assessment to advance diagnosis and offer possible treatment.