Investigating Outcomes of Pediatric Stroke due to Extracranial Arterial Dissection: A Population-Based Cross-Sectional Study of 11,000 Patients.

Abstract

Extracranial arterial dissection (EAD) involving the carotid and vertebral arteries poses a significant risk for acute ischemic stroke (AIS) in children and often presents challenges in diagnosis. The investigation of outcomes and interventions in pediatric AIS secondary to EAD remains significantly underexplored. This retrospective cohort study examines the clinical outcomes of pediatric patients experiencing EAD. The National Inpatient Sample was queried from 2015 to 2019 for pediatric patients aged 0-18 years with a primary diagnosis of AIS, using International Classification of Disease 10th Edition diagnostic codes. Demographic characteristics, comorbidities, acute stroke indices, inpatient complications, and interventions were compared. Outcome measures included length of stay, discharge disposition, and inpatient mortality. Of a total of 11,945 patients diagnosed with AIS, 285 (2.4%) had stroke secondary to EAD. Pediatric patients with EAD-AIS were less likely to have hypertension ( P = 0.007), pneumonia ( P = 0.033), acute kidney injury ( P = 0.024), tracheostomy ( P = 0.007), and mechanical ventilation ( P = 0.003), compared with pediatric patients with strokes due to other etiologies. These patients were also more likely to be adolescents (13-18 years old) and to undergo endovascular thrombectomy and extracranial carotid or vertebral artery stenting ( P < 0.001). In a cohort matched for demographics and severity, EAD-AIS patients had a shorter length of stay ( P < 0.001) and decreased likelihood of in-patient mortality ( P < 0.001), but no significant difference in the likelihood of routine discharge home ( P = 0.054). Identification of potential risk factors for EAD in pediatric patients may help physicians optimize care and prevention strategies for pediatric patients at risk for EAD.