Divisions of Critical Care Medicine and Neurology, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.
Departments of Neurology and Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
Pediatr Neurol. 2019 Nov;100:35-41. doi: 10.1016/j.pediatrneurol.2019.06.008. Epub 2019 Jun 27.
We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease.
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.
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.
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.
我们描述了患有心脏病的儿童围手术期和自发性动脉缺血性卒中（AIS）的危险因素。
我们从 2003 年 1 月至 2014 年 7 月确定了患有以心脏为病因的 AIS 并登记在国际儿科卒中研究注册中心的儿童。孤立的卵圆孔未闭被排除在外。围手术期 AIS（那些发生在心脏手术、心导管术或机械循环支持期间或之后 72 小时内）和在此期间之外发生的自发性 AIS 进行了比较。
我们确定了 672 例患有先天性或获得性心脏病的患者，这些患者的心脏疾病是 AIS 的主要危险因素。其中，177 例（26%）患者患有围手术期 AIS，495 例（74%）患者患有自发性 AIS。在非新生儿中，自发性 AIS 发生在年龄较大时（中位数 4.2 岁，四分位距 0.97 至 12.4），而围手术期 AIS 发生在年龄较小（中位数 2.4 岁，四分位距 0.35 至 6.1，P<0.001）。两组患者中约有三分之一的患者在发生 AIS 时患有全身性疾病。与围手术期 AIS 相比，患有自发性 AIS 的患者更有可能在发生 AIS 前发生血栓事件（16%比 9%，P=0.02），并且在出院时具有中度或重度神经功能缺损（67%比 33%，P=0.01）。
患有心脏病的儿童在心脏手术期间以及手术结束后 72 小时内都有发生 AIS 的风险。许多患者在发生 AIS 之前患有急性全身性疾病或血栓事件，这表明炎症或促血栓形成状态可能在这个易感人群中充当卒中触发因素。
