Childhood arterial ischemic stroke: a review of etiologies, antithrombotic treatments, prognostic factors, and priorities for future research.
Childhood arterial ischemic stroke: a review of etiologies, antithrombotic treatments, prognostic factors, and priorities for future research.
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儿童动脉缺血性中风：病因学、抗血栓治疗、预后因素和未来研究重点的回顾。
DOI：
10.1055/s-0031-1297169
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发表时间：
2011
影响因子：
5.7
通讯作者：
Goldenberg,NeilA
中科院分区：
文献类型：
--
作者：
Lyle,CourtneyA;Bernard,TimothyJ;Goldenberg,NeilA
儿童动脉缺血性卒中(AIS)是一种罕见但严重的疾病，约3%的儿童死亡，70%以上的病例伴有急性和长期神经功能损害。常见的病因包括镰状细胞病、先天性心脏病、动脉夹层、血栓前状态和先前的病毒感染；然而，四分之一的病例被认为是特发性的。到目前为止，还没有进行随机对照临床试验(RCT)来确定当前镰状细胞疾病以外的治疗策略的证据，因此，治疗策略在很大程度上是基于共识的指南，其中，在急性期之后，阿司匹林是主要的治疗药物，抗凝药物只在特定的情况下保留。近年来，关于预后因素的证据已经积累，这有助于为未来的预后分层随机对照试验的设计提供信息。在这篇叙述性综述中，我们讨论了目前对儿童AIS的病因、基于共识的治疗建议、当代治疗数据和预后因素的理解。我们还确定了未来研究的优先事项。
Childhood arterial ischemic stroke (AIS) is a rare, but serious, medical condition, which is fatal in approximately 3% and associated with both acute and long-term neurologic impairment in over 70% of cases. Common etiologies include sickle cell disease, congenital heart disease, arterial dissection, prothrombotic conditions, and preceding viral infections; however, one in four cases is considered idiopathic. To date, no randomized controlled clinical trials (RCTs) have been conducted to establish evidence for current therapeutic strategies outside of sickle cell disease, thus, treatment strategies are largely shaped by consensus-based guidelines, in which, beyond the acute period, aspirin is the mainstay of therapy and anticoagulation is reserved for select circumstances. In recent years, evidence on prognostic factors has accumulated, helping to inform the future design of prognostically stratified RCTs. In this narrative review, we discuss the current understanding of etiologies, consensus-based treatment recommendations, contemporary treatment data, and prognostic factors in childhood AIS. We also identify priorities for future research.