Abstract Details

Title Predictive Validity of Severity Grading for Cerebral Steno-Occlusive Arteriopathy in Recurrent Childhood Ischemic Stroke

Topic Child Neurology/Developmental Neurobiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 096

Objective

Background BACKGROUND: Cerebral arteriopathy is a common risk factor for childhood AIS and recurrence. Arteriopathy includes focal and diffuse vascular abnormalities with heterogeneous pathophysiology and prognosis.

Design/Methods DESIGN/METHODS: Retrospective review of a single center childhood stroke registry identified 49 children with first AIS and steno-occlusive arteriopathy from January 2002 -June 2011. A composite cerebrovascular stenosis score (CVSS),was assigned to the acute MRA by two independent raters, was comprised of the total of scores rating 18 large intracranial arteries for severity of stenosis as: 0, none; 1, 1-50%, low-grade stenosis; 2, 50-99%, high-grade stenosis; 3, 100% occlusion. Chart review was performed by a single reviewer for recurrent stroke (clinical or silent) or TIA. Cox proportional hazards models were used to determine rate of recurrence for increasing score.

Results RESULTS: Eighteen of 49 (37%) children followed for a median of 2.5 (range: 0.8 - 9) years, experienced a recurrence. Median time to recurrence was 0.18 (range: 0.02-2.78) years. ICC for CVSS was very good between the two raters [ICC 0.77 (95%CI 0.63-0.87), p<0.001]. Higher score was associated with higher rate of recurrence [HR per point 1.11 (95% CI 1.03-1.19), p=0.006], for rater1. Recurrence was more than two fold higher for CVSS of >8 [HR 2.60 (95%CI 1.03-6.57), p=0.04],[C statistic 0.64, p=0.11]. Moyamoya disease was associated with recurrence, and adjustment for moyamoya reduced the association between CVSS and rate of recurrence [HR per point 1.08 (95% CI 0.99-1.17), p=0.078].

Conclusions CONCLUSIONS: The CVS score is a reliable measure of severity of steno-occlusive arteriopathy in childhood stroke, and is associated with stroke recurrence in children with a primary arteriopathic ischemic stroke. It may be useful for risk stratification in future trials of secondary stroke prevention.

Authors/Disclosures
Sally Sultan, MD (Neurological Institute of NY) PRESENTER	No disclosure on file
Neil Jouvenat II (University of Nebraska Medical Center/Nebraska Medicine)	No disclosure on file
Lauren A. Beslow, MD	Dr. Beslow has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various . The institution of Dr. Beslow has received research support from NIH. Dr. Beslow has received publishing royalties from a publication relating to health care.
	No disclosure on file
Arastoo Vossough, MD (University of Pennsylvania - Children'S Hospital of Philadelphia)	Dr. Vossough has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Syneos Health. Dr. Vossough has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for DeepSight. Dr. Vossough has received publishing royalties from a publication relating to health care.
Sabrina Smith, MD, PhD (Kaiser Permanente Oakland Medical Center)	No disclosure on file
Daniel J. Licht, MD (Children'S Hospital, Philadelphia)	No disclosure on file
Scott E. Kasner, MD, FAAN (University of Pennsylvania)	Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Javelin. Dr. Kasner has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for UpToDate. The institution of Dr. Kasner has received research support from WL Gore. The institution of Dr. Kasner has received research support from DiaMedica. The institution of Dr. Kasner has received research support from Bayer.
Mitchell S. Elkind, MD, MS, FAAN	Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy.
Rebecca N. Ichord, MD (Perelman School of Medicine of the Univ of Pennsylvania)	No disclosure on file

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