What Causes Childhood Strokes, and Is Stenting an Effective Treatment?

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University at Buffalo neurosurgeon Elad Levy, MD, implanted a stent in an artery inside the skull of a 14-year-old boy to prevent a stroke, a procedure thought to be the first conducted in an adolescent.

The boy was home within one day and remains well at his nine-month evaluation. The boy’s injury, an “intracranial arterial dissection,” a tear along the inside wall of an artery located inside the skull but outside the brain, is an important cause of stroke in young patients.

To date, patients typically receive anti-platelet medication or anticoagulation therapy for this condition. However, neurosurgeons now can treat the dissection more effectively with the advent of self-expanding intracranial stents.

Dr. Levy discusses this innovative procedure below.

Q: How often do strokes occur in children, and what are the usual causes?

Levy: The annual incidence of childhood stroke (0-18 years of age) is 2-13/100,000. Vascular causes are a very important potential reasons for stroke, including dissections, Arteriovenous malformations and moya-moya, an inherited disease in which certain arteries in the brain are constricted. Cardiac and blood-related diseases also are risk factors.

Q: What has been the standard method of treatment?

Levy: The standard treatment for arterial dissections historically has been medications that thin the blood, such as aspirin, and sometimes stronger blood thinners such as coumadin.

Q: What are the benefits of stenting?

Levy:: In this case stenting was the only way to reconstruct the severely narrowed and nearly occluded artery in this boy. Blood thinners help prevent clots from breaking off and causing stroke, but they don’t do anything to repair, or remodel, the artery. In the long-term, cerebral arteries can develop new pathways to deliver blood to the affected area, but when the patient is in immediate danger, as in this case, we wanted a solution that would restore blood flow right away.

Q: Will stenting become the treatment of choice for this injury?

Levy: Stenting is a treatment that should be chosen carefully and used only in select cases, especially in pediatric patients, as it commits the patient to at least 3 months of dual blood thinners and a lifetime of one blood thinner (aspirin), in addition to having a permanent piece of medal in the skull. At this time we don’t know the long-term effects of intracranially stenting.

However, in this case, we thought it was a better option for him to live with ‘hardware’ in his skull than to face a life of potential stroke-related disability.

Note: A full description of the surgery, which took place in September 2009, appears in the August issue of the Journal of Neurosurgery available at http://thejns.org/toc/ped/current.

For information about other faculty experts at the University at Buffalo, go to http://newstips.buffalo.edu

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Source:  University at Buffalo

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