Intracranial and Extracranial Vascular Stenosis as Risk Factors for Stroke in Sickle Cell Disease - 19/12/20
Abstract |
Background |
Prevalence and contribution of intracranial and extracranial arterial stenosis to stroke risk were assessed prospectively in children and young adults with sickle cell disease.
Methods |
In this cross-sectional study, children and young adults (mean = 19.4 years) with sickle cell disease underwent neurological examination, brain MRI, and magnetic resonance angiography of the head and neck. Two neuroradiologists independently recorded infarcts and arterial stenosis. Clinical features and stroke outcomes were compared between participants with and without stenosis and between children and young adults. Logistic regression analysis assessed the association of variables of interest with overt stroke and silent cerebral infarct.
Results |
Of 167 participants (79 children and 88 young adults), 20 (12.0%) had intracranial stenosis, all in the anterior circulation, and nine had concurrent extracranial stenosis. No participants had isolated extracranial stenosis. Participants with intracranial stenosis were more likely than those without stenosis to have an overt stroke (70% vs 5%, P < 0.001) or silent cerebral infarct (95% vs 35%, P < 0.001). Logistic regression analysis indicated that intracranial stenosis was strongly associated with overt stroke when compared with participants with silent cerebral infarct alone and strongly associated with silent cerebral infarct when compared with participants with normal brain MRI; male sex and age were also significant predictors of silent cerebral infarct.
Conclusions |
Intracranial stenosis was strongly associated with both overt stroke and silent cerebral infarct; prevalence of intracranial stenosis was similar to prior estimates in sickle cell disease. Extracranial stenosis without concurrent intracranial stenosis did not occur and thus could not be evaluated as an independent risk factor for stroke.
Le texte complet de cet article est disponible en PDF.Keywords : Stenosis, Stroke, Sickle cell disease, Silent cerebral infarction, Child
Plan
| Declarations of Interests: No disclosures relevant to this work. |
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| Conflicts of Interest: L. C. Jordan receives research support from the National Institutes of Health (NINDS, NHLBI, and NIDDK). She has served as a consultant for bluebird bio. M. J. Donahue receives research support from the American Heart Association, National Institutes of Health (NINDS, NIA, and NINR), and Lipedema Foundation. He also receives research-related support from Philips Healthcare, and consulting or advisory board payments from Global Blood Therapeutics, bluebird bio, and Pfizer. M. R.DeBaun and his institution are the sponsors of two externally funded research investigator-initiated projects. Global Blood Therapeutics (GBT) is providing funding for the cost of the clinical studies but will not be a cosponsor of either study. M. R. DeBaun is not receiving any compensation for the conduct of these two investigator-initiated observational studies. He is a member of the GBT advisory board for a proposed randomized controlled trial for which he receives compensation, and he is the chairperson of a steering committee for an industry-supported phase 2 trial (SPARTAN) for prevention of priapism in SCD. |
Vol 114
P. 29-34 - janvier 2021 Retour au numéro
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