RT Journal Article
SR Electronic
T1 Stroke Recurrence in Children with Vertebral Artery Dissecting Aneurysm
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 913
OP 918
DO 10.3174/ajnr.A7518
VO 43
IS 6
A1 Z. Ritchey
A1 T.J. Bernard
A1 L.Z. Fenton
A1 J.A. Maloney
A1 D.M. Mirsky
A1 I. Neuberger
A1 I. Sriram
A1 J. Seinfeld
A1 N.V. Stence
YR 2022
UL http://www.ajnr.org/content/43/6/913.abstract
AB BACKGROUND AND PURPOSE: Pediatric vertebral artery dissecting aneurysm is a subtype of vertebral artery dissection that can be challenging to diagnose and may be associated with stroke recurrence. This study examines the presenting features, clinical outcomes, and recurrence risk in a cohort of children with vertebral artery dissection, comparing those with aneurysms with those without.MATERIALS AND METHODS: The medical records of children evaluated for vertebral artery dissection were retrospectively reviewed for neurologic presentation, treatment, stroke recurrence, and angiographic appearance of dissection. Cohort patients were categorized into 2 groups based on the presence or absence of a vertebral artery dissecting aneurysm and compared via the Fisher exact test, Student t test, and log-rank analyses. P < .05 was deemed statistically significant.RESULTS: Thirty-two patients met the inclusion criteria, including 13 with vertebral artery dissecting aneurysms. Five cases of vertebral artery dissecting aneurysm were missed on the initial evaluation and diagnosed retrospectively. All patients received antiplatelet or anticoagulation therapy at the time of diagnosis. Children in the vertebral artery dissecting aneurysm group were more likely to present with stroke (P = .059), present at a younger age (P < .001), and have recurrent stroke (P < .001) compared with the group of children with vertebral artery dissection without an aneurysm. After surgery, no patients with vertebral artery dissecting aneurysm experienced recurrent stroke (P = .02).CONCLUSIONS: Vertebral artery dissecting aneurysm is often missed on the initial diagnostic evaluation of children presenting with stroke. In children with vertebral artery dissection, the presence of an aneurysm is associated with stroke presentation at a younger age and stroke recurrence.PCAISposterior circulation arterial ischemic strokeRVACrotational vertebral artery compressionVADvertebral artery dissectionVADAvertebral artery dissecting aneurysm