Steinlin Maja, Bigi Sandra, Stojanovski Belinda, Gajera Jay, Regényi Maria, El-Koussy Marwan, Mackay Mark T
From the Division of Child Neurology, Department of Pediatrics, University Children's Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia (B.S., J.G., M.T.M.); Department of Neuroradiology, University Hospital and University of Bern, Switzerland (M.E.-K.); and the Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia (M.T.M).
Stroke. 2017 Sep;48(9):2375-2382. doi: 10.1161/STROKEAHA.117.016818. Epub 2017 Jul 21.
Focal cerebral arteriopathy accounts for up to 35% of arterial ischemic stroke (AIS) in children and is the most important predictor of stroke recurrence. The study objective was to compare outcomes for children with focal cerebral arteriopathy treated with combined corticosteroid antithrombotic treatment (CAT) to those receiving antithrombotic treatment (AT) alone.
This multicenter retrospective Swiss/Australian cohort study analyzed consecutive children, aged 1 month to 18 years, presenting with first AIS because of a focal cerebral arteriopathy from 2000 to 2014. Children with CAT were compared with those treated with AT. Primary outcome was the presence of neurological deficits at 6 months post-AIS as measured by the Pediatric Stroke Outcome Measure. Secondary outcomes included resolution of stenosis and stroke recurrence. Analysis of covariance was used to adjust for potential confounders (baseline pediatric National Institute of Health Stroke Scale and concomitant acyclovir use).
A total of 73 children (51% males) were identified, 21 (29%) of whom received CAT. Mean (SD) age at stroke for the entire group was 7.9 years (4.7). Median (interquartile range) pediatric National Institute of Health Stroke Scale was 3 (2.0-8.0) in the CAT group and 5 (3.0-9.0) in the AT group (=0.098). Median (interquartile range) Pediatric Stroke Outcome Measure 6 months post-AIS was 0.5 (0-1.5) in the CAT group compared with 1.0 (0.5-2.0) in the AT group (=0.035), the finding was sustained after adjusting for potential confounders. Complete resolution of stenosis at last MRI was noted in 17 (81%) in the CAT group compared with 24 (59%) in the AT group (=0.197). Stroke recurrence occurred in 1 patient in each group.
Corticosteroid treatment may provide additional benefit over AT for improved neurological outcome in childhood AIS because of focal cerebral arteriopathy. Larger prospective studies are warranted to further investigate these differences and understand mechanisms by which steroids modify outcome.
局灶性脑动脉病变在儿童动脉缺血性卒中（AIS）中占比高达35%，是卒中复发的最重要预测因素。本研究的目的是比较接受联合皮质类固醇抗栓治疗（CAT）的局灶性脑动脉病变儿童与仅接受抗栓治疗（AT）的儿童的预后情况。
这项瑞士/澳大利亚多中心回顾性队列研究分析了2000年至2014年间因局灶性脑动脉病变首次发生AIS的1个月至18岁连续儿童。将接受CAT治疗的儿童与接受AT治疗的儿童进行比较。主要结局是根据儿童卒中结局量表测量的AIS后6个月时神经功能缺损的存在情况。次要结局包括狭窄的缓解和卒中复发。采用协方差分析来调整潜在混杂因素（基线儿童国立卫生研究院卒中量表和同时使用阿昔洛韦）。
共确定73名儿童（51%为男性），其中21名（29%）接受了CAT治疗。整个队列卒中时的平均（标准差）年龄为7.9岁（4.7岁）。CAT组儿童国立卫生研究院卒中量表的中位数（四分位间距）为3（2.0 - 8.0），AT组为5（3.0 - 9.0）（P = 0.098）。AIS后6个月时，CAT组儿童卒中结局量表的中位数（四分位间距）为0.5（0 - 1.5），AT组为1.0（0.5 - 2.0）（P = 0.035），在调整潜在混杂因素后该结果仍然成立。在最后一次MRI检查时，CAT组17名（81%）狭窄完全缓解，AT组24名（59%）（P = 0.197）。每组各有1例患者发生卒中复发。
对于因局灶性脑动脉病变导致的儿童AIS，皮质类固醇治疗相较于AT可能在改善神经功能结局方面提供额外益处。有必要开展更大规模的前瞻性研究，以进一步探究这些差异，并了解类固醇改善结局的机制。
