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We evaluated 22 children presenting with &quot;posterior circulation&quot; symptoms with provocative digital catheter angiography with neck rotation and observed &quot;dynamic arterial compression&quot; (DAC) involving the V3 segment where C1 rotates on C2 in 10 children. 17 (14M) presented with stroke, 12 had vertebral artery (VA) dissection, with 3 having &quot;presumed dissection&quot; as stroke mechanism. DAC of the VA was found in 10 (9M), all with observed VA dissection. These 10 were treated with surgical fusion at C1/C2. None had recurrent stroke post op. The 7 without DAC were not treated surgically. AIS etiologies: dissection 2, presumed dissection 3, basilar artery occlusion 1, cardioembolic 1. We presume that in 4 of these 7, supraphysiologic rotation from trauma led to VA dissection but they were not surgically treated as there was no DAC under &quot;normal&quot; degrees of rotation. In 3/7, one VA was either occluded or was unable to be catheterized so could not be assessed. 5 other children (4M) presented with posterior circulation symptoms but did not have AIS. Provocative angiography and did not demonstrate DAC. Etiologies: post-concussion syndrome, opiate ingestion, MELAS, vertebral pseudoaneurysm, and psychogenic. Our observations, particularly of bilateral VA dissection at V3 in 3 children, with high incidence of DAC at this same region suggests that DAC may lead to VA dissection. Our observation of children without DAC demonstrates that such compression is not normal physiology. DAC may be an age or stage of growth-related RF for VA dissection. Other factors, such as arterial wall composition (collagen vascular genetic variants) and hypercoagulable states may also contribute. Our protocol for suspected posterior circulation stroke includes c-spine immobilization, evaluation by provocative digital catheter angiography, with strong consideration for surgical intervention in those demonstrating DAC.

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Is Cupid at risk of Bowhunter&#39;s Syndrome? Vertebral artery compression with neck rotation in children with posterior circulation symptoms

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We evaluated 22 children presenting with "posterior circulation" symptoms with provocative digital catheter angiography with neck rotation and observed "dynamic arterial compression" (DAC) involving the V3 segment where C1 rotates on C2 in 10 children. 17 (14M) presented with stroke, 12 had vertebral artery (VA) dissection, with 3 having "presumed dissection" as stroke mechanism. DAC of the VA was found in 10 (9M), all with observed VA dissection. These 10 were treated with surgical fusion at C1/C2. None had recurrent stroke post op. The 7 without DAC were not treated surgically. AIS etiologies: dissection 2, presumed dissection 3, basilar artery occlusion 1, cardioembolic 1. We presume that in 4 of these 7, supraphysiologic rotation from trauma led to VA dissection but they were not surgically treated as there was no DAC under "normal" degrees of rotation. In 3/7, one VA was either occluded or was unable to be catheterized so could not be assessed. 5 other children (4M) presented with posterior circulation symptoms but did not have AIS. Provocative angiography and did not demonstrate DAC. Etiologies: post-concussion syndrome, opiate ingestion, MELAS, vertebral pseudoaneurysm, and psychogenic. Our observations, particularly of bilateral VA dissection at V3 in 3 children, with high incidence of DAC at this same region suggests that DAC may lead to VA dissection. Our observation of children without DAC demonstrates that such compression is not normal physiology. DAC may be an age or stage of growth-related RF for VA dissection. Other factors, such as arterial wall composition (collagen vascular genetic variants) and hypercoagulable states may also contribute. Our protocol for suspected posterior circulation stroke includes c-spine immobilization, evaluation by provocative digital catheter angiography, with strong consideration for surgical intervention in those demonstrating DAC.

Is Cupid at risk of Bowhunter's Syndrome? Vertebral artery compression with neck rotation in children with posterior circulation symptoms

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**[Download Full Agenda](https://drive.google.com/file/d/1Dm9lJyTfJrvd7-StaHFmUmhXC-J_UgTj/view?usp=sharing)**

Dear IPSO Virtual Conference Attendees:

Welcome to IPSO’s first-ever conference! We are delighted to bring together experts from <u>multiple disciplines</u> and <u>six continents</u> to provide a diverse perspective on pediatric cerebrovascular disease.  

A few quick words about what to expect.  Two important goals of this conference are to (1) foster a sense of community and (2) identify global priorities for our field. Hence, the program includes short presentations on an array of clinical controversies and dedicates more time to panel discussions with a live chat function so that everyone can participate. We are excited to announce IPSO is able to offer 8.75 CME units for the virtual conference. If you would like to claim CME credits, please email  <membership@internationalpediatricstroke.org>. 

We want to hear from you!  Planning for the [IPSO Founding Members’ Congress](https://internationalpediatricstroke.org/2022-congress/) in Vienna, April 24-26, 2022, will commence as soon as the Virtual Conference ends. Let us know your priorities through the live chat function, via email, or by submitting a symposium idea. Based on your input, the Scientific Program Committee will select the topics that we will address in greater depth when we meet again in the spring.

We hope you find the Virtual Conference both interesting and educational, and hope to see you in person in Vienna, or at another IPSO meeting in the future.  

Warm regards,

Heather Fullerton, IPSO President

Adam Kirton, IPSO Vice-President

Lori Jordan, IPSO Secretary & Treasurer


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*Header Photo Credit: Helen Carlson, Ph.D, Alberta Children's Hospital*

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Welcome to the first IPSO Virtual Conference. The mission of the virtual conference is to unify the global community of professionals engaged in research and clinical care for children with cerebrovascular diseases, and chart a path forward for multinational, multidisciplinary efforts.  Please go here to access the virtual conference platform- <a href="https://underline.io/events/157/reception">Reception page</a>. 



Pediatric stroke recovery - from lesion to function: Rethinking what we do - Christine Mrakotsky

Neuroprotection strategies for neonatal and childhood stroke - Kristin Guilliams

Medical and surgical management of moyamoya - Sudhakar Vadivelu

Moyamoya Research in Japan - Miki Fujimura

Moyamoya Research in Japan - Kikutaro Tokairin

Novel Oral Anticoagulants (NOACs) for pediatric stroke prevention - Marcela Torres

Controversies in sickle cell disease - Fenella Kirkham

Controversies in sickle cell disease - Pat McGann

Lessons & challenges from the pandemic - Lauren Beslow

Reperfusion therapy (thrombolysis) is widely used in adults, but the extrapolation of the method to children is impossible because of the age-related features of the hemostasis system and metabolism in children. Aim. Еvaluate the efficacy and safety of thrombolysis in children with arterial ischemic stroke (AIS). Materials: From March 2018 to November 2019, ten children with stroke underwent thrombolysis. Criteria recommended by Thrombolysis in Pediatric Stroke were taken as criteria for selecting patients for thrombolysis. Ten children from 3.5 to 16 years old (average age -10.3g) were included. Results: Patients with stroke had: thrombophilia-2, autoimmune hemolytic anemia-1, polyangiitis-1, Epstein-Barr virus infection-1, transient nocturnal hemoglobinuria with aplastic anemia-1, arteropahty-2, Kavasaki disease -2. The severity of stroke was from 9 to 24 points by PedNIHSS (average -15.8b). The stroke was confirmed by MRI-angiography. The time of start of thrombolysis was from 4 to 10 hours (average 6.3 hours). Thrombolysis in all cases was carried out by the recombinant human tissue plasminogen activator - alteplase. None of our patients had any complications (hemorrhage). MRI control of the efficacy of thrombolysis was carried out after 6-8 hours. In 5 cases, the effect was pronounced: the change on the PedNIHSS scale: from 9 to 2b, from 22 to 8, from 9 to 4, from 10 to 2, from 15 to 6; in five - ineffective: 1- with the infection, two with progressive arteriopathy, one - with polyangiitis, one- transient nocturnal hemoglobinuria with aplastic anemia. A child with polyangiitis and AIS in the basilar artery was thromboextracted after ineffective thrombolysis. Conclusion: In our center, we considered as potential candidates for thrombolysis of all children with AIS who arrived at the clinic no later than 12 hours from the onset of the disease. In our observation, the effectiveness of thrombolysis depended on the etiology of AIS.

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