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The Way Forward: Challenges and Opportunities in Pediatric Stroke

      The past two decades have seen a remarkable increase in publications on pediatric stroke, reflecting increased awareness of its impact on childhood health. The results of the Stroke Prevention Trial in Sickle Cell Anemia (STOP), published in 1998, which showed that chronic blood transfusion decreased the risk of stroke in high-risk children with sickle cell anemia by 92%, revolutionized the care of children with sickle cell anemia
      • Adams R.J.
      • McKie V.C.
      • Brambilla D.
      • et al.
      Stroke prevention trial in sickle cell anemia.
      and highlighted the importance of primary stroke prevention. Surgical revascularization is used increasingly to decrease the risk of ischemic and hemorrhagic stroke in children with moyamoya cerebral arteriopathy.
      • Smith E.R.
      • Scott R.M.
      Spontaneous occlusion of the circle of Willis in children: pediatric moyamoya summary with proposed evidence-based practice guidelines. A review.
      Consensus-based guidelines now exist to guide the care of children with stroke, and prevent stroke recurrence,
      • Roach E.S.
      • Golomb M.R.
      • Adams R.
      • et al.
      Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young.
      • Monagle P.
      • Chan A.K.
      • Goldenberg N.A.
      • et al.
      Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
      while consensus-based standards are being established for pediatric stroke centers of excellence.
      • Bernard T.J.
      • Rivkin M.J.
      • Scholz K.
      • et al.
      Emergence of the Primary Pediatric Stroke Center: Impact of the Thrombolysis in Pediatric Stroke Trial.
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