Thursday, December 3 | 1:50 p.m.-2:00 p.m. | R6-SSNR15-3 | Room E350
Tailored MRI for surveillance of childhood-onset ACTA2 vasculopathy is needed to reduce sedation-related stroke risk, German researchers have reported.
In this Thursday morning session, presenter Dafni Vlachopoulou, MD, of University Hospital Heidelberg in Germany, will share results from a study that included 234 MRI examinations from 52 patients with ACTA2 vasculopathy (median age, eight years).
Childhood-onset steno-occlusive arteriopathy due to pathogenic ACTA2 variants carries a high risk of ischemic strokes and critical stenoses; MRI screening helps track disease progression and evaluate the need for therapeutic intervention, but because pediatric patients often have impaired cerebral autoregulation, the sedation necessary for MR imaging increases their risk of stroke, according to the researchers.
The team conducted a study to explore how best to tailor MRI surveillance intervals in this population. It found that, among 37 patients with six months or more follow-up, eight experienced new strokes. The team reported that baseline independent component analysis (ICA) index was the strongest predictor of these events, followed by the number of critical stenoses and any prior stroke burden. It also found the following risk of stroke percentages in the study participants:
· 0% of patients were low risk, defined as an ICA index <60 and no critical stenoses or prior strokes.
· 43% of patients were intermediate risk, defined as an ICA index 60-75 or one to two critical stenoses.
· 71% of patients were high risk, defined as an ICA index of >75 or ≥3 critical stenoses or prior strokes.
The team proposed a "risk-adaptive surveillance framework incorporating stroke risk and progression rate, supporting MRI intervals of 24 months for stable low-risk patients, nine to 12 months for intermediate-risk patients, and three to six months for high-risk or progressing patients."
Attend this talk for all of the details.
