Open AccessPredictive validity of severity grading for cerebral steno‐occlusive arteriopathy in recurrent childhood ischemic stroke
Author(s) -
Sultan Sally M.,
Beslow Lauren A.,
Vossough Arastoo,
Elkind Mitchell S. V.,
Kasner Scott E.,
Mirsky David M.,
Licht Daniel J.,
Ichord Rebecca N.
Publication year - 2015
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1111/ijs.12344
Subject(s) - medicine , hazard ratio , confidence interval , intraclass correlation , moyamoya disease , proportional hazards model , stenosis , cohort , cardiology , stroke (engine) , occlusion , mechanical engineering , clinical psychology , engineering , psychometrics
Background Cerebral arteriopathy is a risk factor for incident and recurrent childhood AIS . There are no standardized criteria to quantify arteriopathy severity. Aims To evaluate a method of scoring severity of steno‐occlusive arteriopathy in childhood arterial ischemic stroke ( AIS ) and its association with recurrence. Methods In a single‐center prospectively enrolled cohort of 49 children with first AIS and arteriopathy, a composite cerebrovascular stenosis score ( CVSS ) was measured by two independent raters as the sum of stenosis scores in each of 18 intracranial large and medium arteries, where 0 = none; 1 = low‐grade, 1–50%; 2 = high‐grade, >50–99%; 3 = occlusion, 100%. Cox proportional‐hazards models were used to determine the association of CVSS with recurrence. The analysis was stratified by presence or absence of moyamoya arteriopathy (syndrome or disease). Results At a median follow‐up period of 2·5 years (range: 0·8–9), 18/49 children (37%) experienced a recurrence. Median time to recurrence was 0·2 (range: 0·02–2·8) years. Interrater agreement was good, with an intraclass correlation coefficient of 0·77 [95% confidence interval ( CI ) 0·63–0·87, P < 0·001). Higher CVSS was associated with higher recurrence rate [hazard ratio ( HR ) per point 1·09, 95% CI 1·04–1·16, P = 0·001]. Among those with moyamoya arteriopathy, CVSS was associated with recurrence ( HR per point of CVSS 1·11, 95% CI 1·03–1·19, P = 0·004), but there was no association in those without moyamoya arteriopathy ( HR per point of CVSS 0·91, 95% CI 0·75–1·09, P = 0·32). Conclusions The CVSS is a reliable measure of severity of steno‐occlusive arteriopathy in childhood stroke. This preliminary study suggests that higher CVSS is associated with stroke recurrence in children with moyamoya arteriopathy.