Abstract TP410: Early Radiographic Recurrence or Extension Predicts Late Clinical Recurrence in Pediatric Acute Ischemic Stroke

Abstract

Introduction: Pediatric AIS has a high recurrence rate of 10-25%. We observed a high rate of early radiographic recurrence or extension of stroke on repeat MRI performed within 2 weeks of index stroke and hypothesized that early radiographic extension of stroke or recurrent stroke would predict late clinical recurrence. Methods: IRB approved retrospective chart review of children ages 1 week to 18 years with AIS in our institutional pediatric stroke database who had repeat MRI within two weeks of initial acute presentation. We collected clinical and demographic data and reviewed f/u MRI studies for the presence of extension, new stroke, and hemorrhage. Results: 70 patients had early repeat MRI. 23 (33%) had early extension or new stroke on repeat MRI. Of these, 5 (21.7 %) had late clinical recurrence while only 1/47 (2.2%) who did not have early recurrence/extension went on to have late recurrence. 4/70 (5.7 %) had hemorrhagic conversion (only one was symptomatic -headache). Radiographic extension or new stroke on early repeat MRI was significantly associated with late recurrence (p=0.013). Using logistic regression, early extension/recurrence was found to be predictive of late recurrence, (OR 19.5, 95%CI 1.7-228). Conclusion: Children with AIS have a high rate of ongoing early, clinically silent, ischemic injury despite anticoagulation or antiplatelet therapy, which is associated with late clinical recurrence. This early imaging finding may serve as a biomarker that might prove useful as an endpoint in clinical trials comparing early antithrombotic therapies or to identify patients at higher risk of subsequent recurrent overt stroke who might benefit from intensified therapy. Given the high rate of early and late recurrence and low hemorrhage rates from current antithrombotic therapies, more aggressive therapy with dual antithrombotic agents should be investigated.