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To describe the clinical characteristics of dissections of cerebral arteries in children.

Technically uncomplicated percutaneous angioplasty and stent placement of a left subclavian artery stenosis was performed in a 56-year-old man for treatment of subclavian steal syndrome and vertebrobasilar insufficiency. Six days later the patient was readmitted with Staphylococcus aureusbacteremia and stigmata of septic emboli isolated to the ipsilateral hand. Nine days later he had computed tomography (CT) evidence of a contrast-enhancing phlegmon surrounding the stent. Despite clinical improvement and resolution of bacteremia on intravenous antibiotic therapy, the phlegmon progressed, and at day 21 a pseudoaneurysm was angio-graphically confirmed. The patient underwent surgical removal of the stented arterial segment and successful autogenous arterial reconstruction. The possible contributory factors leading to stent infection were prolonged right femoral artery access and an infected left arm venous access. Although the role of prophylactic antibiotics remains to be defined, it may be important in cases where the vascular access sheath remains in place for a prolonged period of time.

Introduction:Large Vessel Occlusion (LVO) prediction scales are used to triage prehospital suspected stroke patients with a high probability of LVO stroke to endovascular therapy centers. The sensitivities of these scales in the 6 to 24 hour window are unknown. Higher scale score thresholds are typically less sensitive and more specific. Knowing the highest scale score thresholds that remain sensitive could inform threshold selection for clinical use. Sensitivities may also vary between left and right sided LVOs.Methods:LVO prediction scale scores were retrospectively calculated using the NIHSS sub-item scores of patients enrolled in the DAWN Trial. All patients had last known well times between 6 to 24 hours, NIHSS scores ≥ 10, intracranial ICA or proximal MCA occlusions, and mismatches between their exam severities and infarct core volumes. Scale thresholds with sensitivities ≥ 85% were identified. Scores ≥ 5% more sensitive for left or right sided LVOs were identified. Specificities could not be calculated because all DAWN Trial patients had LVOs.Results:201 out of 206 patients had the required NIHSS sub-item scores. The highest score thresholds that maintained sensitivities ≥ 85% are bolded in the table.Conclusions:CPSS = 3, C-STAT ≥ 2, FAST-ED ≥ 4, G-FAST ≥ 3, RACE ≥ 5, and SAVE ≥ 3 are likely the highest thresholds that can be selected for extended window LVO triage without missing more than 15% of DAWN Trial eligible LVO strokes. For CPSS and SAVE, these are higher than the thresholds suggested by prior studies. CPSS = 3 and RACE ≥ 5 were more sensitive for right sided LVOs. These findings represent the maximum anticipated sensitivities of LVO prediction scales since the NIHSS scores were documented in hospitals during a clinical trial rather than in the prehospital setting. Inclusion of lower NIHSS or more distal LVO patients would lower sensitivities further. Selecting even higher scale thresholds for LVO triage would lead to many missed LVO strokes.