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2060. Stroke Recurrence in Children with Dissecting Aneurysm of the Vertebral Artery
Authors * Denotes Presenting Author
  1. Zak Ritchey *; University of Colorado School of Medicine
  2. Timothy Bernard; Children’s Hospital Colorado; University of Colorado School of Medicine
  3. Laura Fenton; Children’s Hospital Colorado; University of Colorado School of Medicine
  4. John Maloney; Children’s Hospital Colorado; University of Colorado School of Medicine
  5. David Mirsky; Children’s Hospital Colorado; University of Colorado School of Medicine
  6. Ilana Neuberger; Children’s Hospital Colorado; University of Colorado School of Medicine
  7. Nicholas Stence; Children’s Hospital Colorado; University of Colorado School of Medicine
Objective:
Vertebral artery dissection (VAD) is a known cause of pediatric posterior circulation arterial ischemic stroke (AIS). At our institution, we have encountered a subset of pediatric posterior circulation AIS patients with a more malignant clinical course and frequent recurrent strokes. Many were eventually found to have dissecting aneurysms of the vertebral artery (DAVA), a rare subtype of VAD that is often challenging to diagnose. While some published manuscripts have described features and risk factors of pediatric AIS with VAD, to our knowledge none have differentiated the unique clinical attributes and outcomes of pediatric DAVA. As such, the aim of this study was to assess the presenting features and clinical outcomes in a cohort of children with VAD, comparing those with DAVA to those without.

Materials and Methods:
This single-center, HIPAA-compliant retrospective study was approved by the institutional review board. The medical records of pediatric patients who were evaluated for AIS between 2000 and 2020 were reviewed for the following inclusion criteria: 1) age between 1 month and 18 years at time of presentation, 2) neurologic deficit suspicious for transient ischemic attack (TIA) or AIS at presentation, and 3) VAD confirmed on angiography. Children diagnosed with VAD were separated into two comparison groups based on the presence or absence of DAVA. Data analysis was performed by Fisher’s exact test or Student’s t test. P < 0.05 was deemed statistically significant.

Results:
Thirty patients met inclusion criteria, including 12 with DAVA. Of note, 5 cases of DAVA were diagnosed upon retrospective review and not recognized in the initial angiography report. Nineteen of 30 patients (63%) were male, with an age range at presentation of 0.9-17 years (mean 9.23 years). All patients in the cohort received antiplatelet or anticoagulation therapy at time of diagnosis. Compared to the non-DAVA group, the DAVA group was more likely to present with AIS or TIA-like symptoms at a younger age (5.6 years vs 11.7, P=0.0012). Twelve of the 18 patients (66%) in the non-DAVA group presented with stroke (the other 6 being diagnosed with TIA), while all 12 DAVA patients presented with stroke (P=0.0568). Stroke recurrence occurred only in patients with DAVA (8/12 vs 0/18, P<0.0001).

Conclusion:
DAVA is a subtype of VAD that is not uncommonly missed on initial diagnostic evaluation of children who present with posterior circulation AIS. In our cohort of children with VAD, the presence of DAVA was associated with an increased risk of recurrent stroke even when appropriate therapy was initiated at diagnosis.