Survivors of Childhood Cancer Have High-Risk of Recurrent Stroke

Once again the fixation on preventing stroke shows up. We should be having a multi-pronged approach. But this isn't going to occur until we get a great stroke association.
1. Replace the 88% failure rate of tPA
2. Solve the neuronal cascade of death.
3. Solve all the problems in stroke.
http://dgnews.docguide.com/survivors-childhood-cancer-have-high-risk-recurrent-stroke?
New evidence suggests that childhood cancer survivors who have experienced a stroke have double the risk of suffering a second stroke, when compared with non-cancer stroke survivors.
The study, published in the online edition of the journal Neurology, found that the main predictors of recurrent stroke were cranial radiation therapy, hypertension, and older age at first stroke -- factors that could help physicians identify high-risk patients.
The findings provide strong evidence for adjusting secondary stroke prevention strategies in these patients, and to aggressively detect and treat modifiable stroke risk factors, such as hypertension.
“We are at a point where more children are surviving cancer because of life-saving interventions,” said Sabine Mueller, MD, Pediatric Brain Tumor Center at the University of California at San Francisco, San Francisco, California. “Now, we are facing long-term problems associated with these interventions.”
The researchers analysed retrospective data from the Childhood Cancer Survivor Study (CCSS), which has followed 14,358 survivors diagnosed between 1970 and 1986 in the United States and Canada to track long-term outcomes of cancer treatment. All of the recruits were diagnosed with cancer before age 21.
To assess stroke recurrence rates, the researchers sent a second survey to participants who had reported a first stroke, asking them to confirm their first stroke and report if and when they had had another. The researchers analysed the respondent demographics and cancer treatments to identify any potential predictors of recurrent strokes.
Of the 271 respondents who reported having had a stroke, 70 also reported a second one. Overall, the rate of recurrence within the first 10 years after an initial stroke was 21%, which is double the rate of the general population of stroke survivors. The rate was even higher -- 33% for patients who had received cranial radiation therapy.
Previous research has shown that radiation therapy targeting the head is a strong predictor of a first stroke. In an earlier study, the authors found that children treated for brain tumours were 30 times more likely to suffer a stroke compared with their siblings. While the exact mechanisms are unclear, the scientists think high-dose radiation causes the blood vessels to constrict and encourage blockage.
“If they have 1 stroke, it’s not actually surprising that they have a high risk of getting another stroke,” said Heather Fullerton, MD, University of California at San Francisco. “You might use aspirin after the first stroke to try to reduce blood clots, but you’re not making those diseased blood vessels go away.”
The findings have significant implications for medical follow-up in childhood cancer patients. The authors said that current survivor screening guidelines do not recommend checking for diseased blood vessels, even though the signs are visible in standard MRIs.
“The radiologists are so focused on looking in the brain area where the tumour used to be that they’re not looking at the blood vessels,” said Dr. Fullerton.
Based on the findings, the University of California San Francisco has updated protocols for monitoring patients to include screening for both blood vessel injury and modifiable stroke risk factors, but it is not required on a national level.
“If we could identify high-risk patients, we could recommend they be followed by a paediatric stroke specialist,” said Dr. Mueller. “That will be huge in providing effective follow-up care for these children.”
SOURCE: University of California, San Francisco