Stroke in children with congenital or acquired heart disease

PURPOSE OF REVIEW: Children with congenital or acquired cardiac disease are at increased risk for both ischemic and hemorrhagic stroke. This review covers the epidemiology, presentation, acute management, and outcomes of stroke in children with heart disease. RECENT FINDINGS: The major advances in endovascular thrombectomy for adults with large vessel occlusions (LVOs) have had significant ramifications for children with cardioembolic stroke, who often present with LVO. Several large registry studies have shown that thrombectomy likely improves outcomes for children with LVO, including those with acquired or congenital heart disease. Improving both primary and secondary stroke prevention remains both vital and challenging; as more children with congenital heart disease survive into adulthood, studies show that they remain at increased risk for stroke and may be susceptible to earlier frailty and cognitive impairment. SUMMARY: Children with cardiac disease have a lifelong increased risk of stroke. While new interventions such as thrombectomy may improve outcomes, more research is needed to improve long term neurologic outcomes in this population.