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Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis?

Lookup NU author(s): Dr Rob ForsythORCiD


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© 2016 American Heart Association, Inc. Background and Purpose - Arteriopathy is the leading cause of childhood arterial ischemic stroke. Mechanisms are poorly understood but may include inherent abnormalities of arterial structure. Extracranial dissection is associated with connective tissue disorders in adult stroke. Focal cerebral arteriopathy is a common syndrome where pathophysiology is unknown but may include intracranial dissection or transient cerebral arteriopathy. We aimed to quantify cerebral arterial tortuosity in childhood arterial ischemic stroke, hypothesizing increased tortuosity in dissection. Methods - Children (1 month to 18 years) with arterial ischemic stroke were recruited within the Vascular Effects of Infection in Pediatric Stroke (VIPS) study with controls from the Calgary Pediatric Stroke Program. Objective, multi-investigator review defined diagnostic categories. A validated imaging software method calculated the mean arterial tortuosity of the major cerebral arteries using 3-dimensional time-of-flight magnetic resonance angiographic source images. Tortuosity of unaffected vessels was compared between children with dissection, transient cerebral arteriopathy, meningitis, moyamoya, cardioembolic strokes, and controls (ANOVA and post hoc Tukey). Trauma-related versus spontaneous dissection was compared (Student t test). Results - One hundred fifteen children were studied (median, 6.8 years; 43% women). Age and sex were similar across groups. Tortuosity means and variances were consistent with validation studies. Tortuosity in controls (1.346±0.074; n=15) was comparable with moyamoya (1.324±0.038; n=15; P=0.998), meningitis (1.348±0.052; n=11; P=0.989), and cardioembolic (1.379±0.056; n=27; P=0.190) cases. Tortuosity was higher in both extracranial dissection (1.404±0.084; n=22; P=0.021) and transient cerebral arteriopathy (1.390±0.040; n=27; P=0.001) children. Tortuosity was not different between traumatic versus spontaneous dissections (P=0.70). Conclusions - In children with dissection and transient cerebral arteriopathy, cerebral arteries demonstrate increased tortuosity. Quantified arterial tortuosity may represent a clinically relevant imaging biomarker of vascular biology in pediatric stroke.

Publication metadata

Author(s): Wei F, Diedrich KT, Fullerton HJ, DeVeber G, Wintermark M, Hodge J, Kirton A, Dowling MM, Benedict SL, Bernard TJ, Fox CK, Friedman NR, Lo WD, Ichord RN, Tan MA, Mackay MT, Hernandez Chavez MI, Humphreys P, Jordan LC, Sultan SM, Rivkin MJ, Rafay MF, Titomanlio L, Kovacevic GS, Yager JY, Amlie-Lefond C, Dlamini N, Condie J, Yeh EA, Kneen R, Bjornson BH, Pergami P, Zou LP, Elbers J, Abdalla A, Chan AK, Farooq O, Lim MJ, Carpenter JL, Pavlakis S, Wong VCN, Forsyth R

Publication type: Article

Publication status: Published

Journal: Stroke

Year: 2016

Volume: 47

Issue: 5

Pages: 1265-1270

Print publication date: 01/05/2016

Online publication date: 22/03/2016

Acceptance date: 01/01/1900

ISSN (print): 0039-2499

ISSN (electronic): 1524-4628

Publisher: Lippincott Williams and Wilkins


DOI: 10.1161/STROKEAHA.115.011331


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