PDF(Pubmed)
Abstract：
The characteristics of large vessel occlusion (LVO) in the acute phase of pediatric arterial ischemic stroke and their natural history according to stroke etiology are poorly explored. This studied aimed at describing the prevalence and the radiological evolution of LVO in pediatric AIS.
This single-center retrospective study included consecutive non-neonate children with acute arterial ischemic stroke, intracranial proximal LVO in the anterior circulation (MCA, anterior cerebral artery, and/or ICA), and clinical and imaging follow-up for at least 18 months, during a 9-year period.
Intracranial LVO was observed in 24.8% of patients with anterior circulation arterial ischemic stroke and adequate follow-up (n = 26/105), with a median age of 4.2 years (IQR 0.8-9), sex ratio 1.16. The main stroke etiology associated with LVO was unilateral focal cerebral arteriopathy (n = 12, 46%). During follow-up, a specific pattern of unilateral poststroke anastomotic bridge was observed in 8/26 patients, with the poststroke development of nonperforating collaterals forming a bridge in bypass of the LVO site with visible distal flow, within a median delay of 11 months. The development of unilateral poststroke anastomotic bridge was only observed in patients with unilateral focal cerebral arteriopathy. No patient with this pattern experienced stroke recurrence or further progressive vascular modifications.
After stroke, the development of unilateral poststroke anastomotic bridge is specifically observed in children with focal cerebral arteriopathy, appearing in the first year after stroke. This clinical-radiologic pattern was not associated with stroke recurrence or arterial worsening, differentiating it from progressive intracranial arteriopathy, such as Moyamoya angiopathy.
This single-center retrospective study included consecutive non-neonate children with acute arterial ischemic stroke, intracranial proximal LVO in the anterior circulation (MCA, anterior cerebral artery, and/or ICA), and clinical and imaging follow-up for at least 18 months, during a 9-year period.
Intracranial LVO was observed in 24.8% of patients with anterior circulation arterial ischemic stroke and adequate follow-up (n = 26/105), with a median age of 4.2 years (IQR 0.8-9), sex ratio 1.16. The main stroke etiology associated with LVO was unilateral focal cerebral arteriopathy (n = 12, 46%). During follow-up, a specific pattern of unilateral poststroke anastomotic bridge was observed in 8/26 patients, with the poststroke development of nonperforating collaterals forming a bridge in bypass of the LVO site with visible distal flow, within a median delay of 11 months. The development of unilateral poststroke anastomotic bridge was only observed in patients with unilateral focal cerebral arteriopathy. No patient with this pattern experienced stroke recurrence or further progressive vascular modifications.
After stroke, the development of unilateral poststroke anastomotic bridge is specifically observed in children with focal cerebral arteriopathy, appearing in the first year after stroke. This clinical-radiologic pattern was not associated with stroke recurrence or arterial worsening, differentiating it from progressive intracranial arteriopathy, such as Moyamoya angiopathy.
摘要：
目的：对小儿动脉性缺血性卒中急性期大血管闭塞（LVO）的特征及其根据卒中病因的自然史研究甚少。这项研究旨在描述小儿AIS中LVO的患病率和放射学演变。
方法：这项单中心回顾性研究包括连续的非新生儿急性动脉缺血性卒中儿童，前循环颅内近端LVO（MCA，大脑前动脉,和/或ICA)，临床和影像学随访至少18个月，在9年期间。
结果：在24.8%的前循环动脉缺血性卒中患者中观察到颅内LVO并进行了充分的随访（n=26/105），年龄中位数为4.2岁（IQR0.8-9），性别比1.16。与LVO相关的主要卒中病因是单侧局灶性脑动脉病（n=12，46％）。随访期间,在8/26例患者中观察到单侧卒中后吻合桥的特定模式，随着中风后非穿孔侧支的发展，在LVO部位的旁路中形成桥梁，并具有可见的远端流动，平均延迟11个月。仅在单侧局灶性脑动脉病患者中观察到单侧卒中后吻合桥的发展。没有这种模式的患者出现中风复发或进一步进行性血管改变。
结论：中风后，在患有局灶性脑动脉病的儿童中观察到单侧卒中后吻合桥的发展。出现在中风后的第一年。这种临床放射学模式与卒中复发或动脉恶化无关，将其与进行性颅内动脉病区分开来，比如烟雾病。
方法：这项单中心回顾性研究包括连续的非新生儿急性动脉缺血性卒中儿童，前循环颅内近端LVO（MCA，大脑前动脉,和/或ICA)，临床和影像学随访至少18个月，在9年期间。
结果：在24.8%的前循环动脉缺血性卒中患者中观察到颅内LVO并进行了充分的随访（n=26/105），年龄中位数为4.2岁（IQR0.8-9），性别比1.16。与LVO相关的主要卒中病因是单侧局灶性脑动脉病（n=12，46％）。随访期间,在8/26例患者中观察到单侧卒中后吻合桥的特定模式，随着中风后非穿孔侧支的发展，在LVO部位的旁路中形成桥梁，并具有可见的远端流动，平均延迟11个月。仅在单侧局灶性脑动脉病患者中观察到单侧卒中后吻合桥的发展。没有这种模式的患者出现中风复发或进一步进行性血管改变。
结论：中风后，在患有局灶性脑动脉病的儿童中观察到单侧卒中后吻合桥的发展。出现在中风后的第一年。这种临床放射学模式与卒中复发或动脉恶化无关，将其与进行性颅内动脉病区分开来，比如烟雾病。
