Abstract Details

Title A Standardized MRA Scanning Protocol Leading To Changes In Stroke Prevention Treatment Plan for Pediatric Sickle Cell Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 154

Objective The primary objective of this study was to document any change in stroke prevention therapy that could be attributed to the implementation of a standardized MRA (Magnetic Resonance Angiography) scanning protocol.

Background MRA is performed on pediatric patients with sickle cell disease (SCD) to classify degree of cerebrovascular stenosis, informing stroke risk and treatment plan for stroke prevention. Flow artifact intrinsic to MRA with technician dependent factors can lead to over-interpretation of stenosis.

Design/Methods A standardized MRA scanning protocol with an echo time (TE) of <5msec was implemented at Montefiore Medical Center, NY (MMC) in May of 2016. This project included a retrospective chart review of patients at MMC ≤ 21 years with SCD who had an MRA head pre- AND post-May 2016. Of the 81 patients that met inclusion criteria, 29 patients were found to have vasculopathy on pre-May 2016 imaging and were included in this analysis. Level of arterial stenosis on MRA, TE, and treatment plans were documented both pre- and post-May 2016. McNemar analysis was used to determine the significance of change in treatment plans before and after implementation of the standardized scanning protocol.

Results 24/29 (83%) patients were on chronic transfusion therapy for CNS vasculopathy pre-May 2016 whereas 18/29 (62%) required chronic transfusion therapy post May 2016. Notably, 6 patients had a resolution of vasculopathy on MRA leading to discontinuation of chronic transfusion therapy whereas 0 patients required escalation of therapy to chronic transfusions. McNemar analysis showed this difference to be statistically significant (p = 0.042).

Conclusions Implementing a standardized MRA scanning protocol allowed for chronic transfusion therapy, which can have significant side effects, to be discontinued in 6 of 24 patients. Minimizing flow artifact with TE <5msec can improve accurate interpretation of true cerebrovascular disease and ensure appropriate treatment plans are in place for stroke prevention in SCD.

Authors/Disclosures
Parmpreet Dhillon, MD (Albert Einstein College of Medicine, Bronx, Child Neurology) PRESENTER	Dr. Dhillon has nothing to disclose.
	No disclosure on file
	No disclosure on file
Daniel Lax, MD (Montefiore Medical Center)	Dr. Lax has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Theranica. Dr. Lax has received personal compensation in the range of $500-$4,999 for serving as a CME Lecturer with American Headache Society.
	No disclosure on file

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Abstract Details