Abstract TP406: Risk of Recurrent Childhood Stroke Differs by Vasculopathy Subtype

Abstract

Introduction: Head and neck vasculopathies are the most frequent identifiable cause of childhood arterial ischemic stroke, and abnormal vascular imaging is associated with higher risk of stroke recurrence. Despite this, little is known about how vasculopathy subtype impacts risk of both initial and recurrent stroke. In this single-center retrospective analysis, we analyze differences in stroke recurrence by vasculopathy subtype. Methods: Using ICD codes, we identified children treated for a head or neck vasculopathy at our tertiary care center between 2003 and 2019. Inclusion criteria included imaging-confirmed head or neck vasculopathy diagnosed between the ages of 28 days and 18 years. Retrospective chart review was carried out with attention to vasculopathy subtype and occurrence/recurrence of stroke and TIA. Results: Ninety-three patient met inclusion criteria, including 55 who experienced a stroke. Five-year stroke recurrence rates differed significantly by vasculopathy subtype (n=28, p=0.030, Fisher exact test), as patients with moyamoya disease (MMD) and sickle cell, Down syndrome, or neurofibromatosis-related vasculopathy experienced higher recurrence rates. There was a non-significant increased rate of stroke recurrence among patients with secondary versus primary MMD. Conclusions: Children with primary and secondary MMD have a higher risk of stroke recurrence than children with other vasculopathy subtypes. Further studies are needed to evaluate the effect of vasculopathy etiology and other radiographic and clinical characteristics on stroke recurrence risk so that appropriate treatment strategies can be implemented early in these high-risk patients.