Fullerton Heather J, Hills Nancy K, Chen Hui, Dlamini Nomazulu, Stence Nicholas V, Wintermark Max
Departments of Neurology (H.J.F., N.K.H.), University of California San Francisco.
Pediatrics (H.J.F.), University of California San Francisco.
Stroke. 2025 Jun;56(6):1460-1468. doi: 10.1161/STROKEAHA.124.050550. Epub 2025 May 12.
The most common cause of arterial ischemic stroke in healthy children, focal cerebral arteriopathy (FCA), can progress rapidly over days with worsening brain injury. A 2017 retrospective Swiss study of corticosteroid treatment for FCA changed practice. To assess its impact, we compared the FCA cohorts from the 2 VIPS (Vascular Effects of Infection in Pediatric Stroke) prospective cohort studies.
The VIPS II study prospectively enrolled 205 children (29 days to 18 years) with arterial ischemic stroke at 22 centers, December 2016 to January 2022. The local team measured 12-month outcomes using the pediatric stroke outcome measure. A neuroradiologist and pediatric vascular neurologist independently reviewed all clinically obtained imaging and clinical data to classify the cause of arterial ischemic stroke. The neuroradiologist measured the FCA Severity Score on vascular imaging performed at any time poststroke. We compared the VIPS II FCA cohort to the previously published FCA cohort from VIPS I (2010-2014; 37 centers).
Of 75 children with definite arteriopathy enrolled in VIPS II, 32 (43%) had FCA, compared with 41 of 127 (32%) of definite arteriopathy cases in VIPS I. The median age was 11.3 years (56% male) in VIPS I and 11.4 years (55%) in VIPS II. Treatment with intravenous corticosteroids increased from 2 of 41 (5%) of FCA patients in VIPS I to 18 of 32 (56%) in VIPS II. The VIPS II FCA cases were more severe at baseline (median FCA Severity Score 6 versus 4; =0.006). There were no significant differences in either the change in FCA Severity Score (baseline to maximum) or the 12-month neurological outcomes.
Treatment of FCA with corticosteroids increased dramatically between the VIPS I and VIPS II studies. VIPS II cases were more severe at baseline, but we observed no significant difference in disease progression or neurological outcomes. Given the low level of evidence supporting corticosteroid therapy, pediatric stroke centers should enroll FCA patients into ongoing FCA corticosteroid treatment trials.
URL: https://www.clinicaltrials.gov; Unique identifiers: NCT04873583 and NCT06040255.
在健康儿童中，动脉缺血性卒中最常见的病因是局灶性脑动脉病（FCA），其可在数天内迅速进展，导致脑损伤加重。2017年瑞士一项关于FCA皮质类固醇治疗的回顾性研究改变了治疗方式。为评估其影响，我们比较了两项VIPS（儿童卒中感染的血管效应）前瞻性队列研究中的FCA队列。
VIPS II研究于2016年12月至2022年1月在22个中心前瞻性纳入了205名动脉缺血性卒中患儿（年龄29天至18岁）。当地团队使用儿童卒中结局测量指标评估12个月的结局。一名神经放射科医生和一名儿童血管神经科医生独立审查所有临床获取的影像学和临床数据，以对动脉缺血性卒中的病因进行分类。神经放射科医生在卒中后任何时间进行的血管成像上测量FCA严重程度评分。我们将VIPS II的FCA队列与之前发表的VIPS I（2010 - 2014年；37个中心）的FCA队列进行了比较。
在VIPS II纳入的75名确诊动脉病患儿中，32名（43%）患有FCA，而在VIPS I的127名确诊动脉病病例中有41名（32%）患有FCA。VIPS I队列的中位年龄为11.3岁（男性占56%），VIPS II队列为11.4岁（男性占55%）。静脉注射皮质类固醇的治疗比例从VIPS I中41名FCA患者中的2名（5%）增加到VIPS II中32名患者中的18名（56%）。VIPS II的FCA病例在基线时病情更严重（FCA严重程度评分中位数为6对4；P = 0.006）。FCA严重程度评分的变化（从基线到最高值）或12个月的神经学结局均无显著差异。
在VIPS I和VIPS II研究期间，皮质类固醇治疗FCA的情况有显著增加。VIPS II的病例在基线时病情更严重，但我们观察到疾病进展或神经学结局无显著差异。鉴于支持皮质类固醇治疗的证据水平较低，儿童卒中中心应将FCA患者纳入正在进行的FCA皮质类固醇治疗试验。
网址：https://www.clinicaltrials.gov；唯一标识符：NCT04873583和NCT06040255。
