Stroke and Cerebrovascular Center

The current standard of care for adults, if the stroke is caught early, is to give intravenous tissue plasminogen activator (tPA) to dissolve any blood clot that might be causing the stroke. The Stroke and Cerebrovascular Center served as a primary enrollment center and core imaging center for the National Institutes of Health-funded Thrombolysis in Pediatric Stroke (TIPS) study, which investigated intravenous tPA treatment for children presenting with 4.5 hours of onset of acute ischemic stroke. Recently published studies led by investigators in the Stroke and Cerebrovascular Center found that providing TIPS training to pediatric centers significantly increased their readiness to treat children with acute stroke.

Michael Rivkin, MD; Laura Lehman, MD; and Cameron Trenor, MD, participate in the International Pediatric Stroke Study, a collaborative research project that collects standardized data on the diagnosis, investigation, treatment, and outcome of children with stroke to better understand stroke conditions in newborns and older children. The information is shared in an international data repository used to help practitioners around the world better understand stroke in children. Ultimately, this data will lead to clinical trials.

The Vascular Effects of Infection in Pediatric Stroke (VIPS) Study is an NIH-funded multicenter study led at Boston Children’s Hospital by Michael Rivkin, MD, that explores the hypothesis that infection can lead to arterial ischemic stroke in children by injuring the blood vessels, and that the resulting arterial damage and biochemical markers of inflammation can predict additional stroke.

The Seizures in Pediatric Stroke (SIPS) study is an NIH-funded multicenter study led at Boston Children’s Hospital by Laura Lehman, MD, that explores the hypothesis that infection can lead to arterial ischemic stroke in children by injuring the blood vessels, and that the resulting arterial damage and biochemical markers of inflammation can predict additional stroke.

Laura Lehman, MD, is actively researching TIAs in children and their relationship with subsequent stroke. She has presented her work at the International Stroke Conference and has published her findings, with Amy Danehy, MD, and Miya Bernson-Leung, MD, EdM, as co-authors.

Malformations of the blood vessels are a common cause of stroke in children. Darren Orbach, MD, PhD, and Edward Smith, MD, maintain a comprehensive, dynamic database of patients with cerebrovascular disease — representing the largest pediatric experience in the world — allowing them to conduct research evaluating interventions and patient outcomes over time. For more information, visit their research page and view their selected papers.

Michael Rivkin, MD, and Amy Danehy, MD, are investigating non-invasive perfusion magnetic resonance imaging as a method to look at the brain’s blood supply and circulation in newborns and older children who are having or have had a stroke. Such imaging avoids the need to inject dye for use as intravascular contrast, does not require an IV, and poses no risk of damaging or rupturing a blood vessel. Read some results of this research.

This study, co-led by Annette Correia, OT, of the Occupational Therapy Service, is testing a specially designed, powered orthotic device called IOTA that is designed to help children with stroke and other conditions regain use of their thumbs.

Research by Cameron Trenor, MD, aims to understand the mechanism of small artery blood clot formation, similar to what occurs in some stroke patients. He is also interested in vascular anomalies, which can lead to stroke or bleeding around or within the brain.

Christine Mrakotsky, PhD, is studying children with extensive neuropsychological evaluations to determine the ways in which stroke affects children’s developing cognition.

Laura Lehman, MD, and Cameron Trenor, MD, have led an important study of blood clotting assessment in neonates with stroke. In addition, Miya Bernson-Leung, MD, EdM, and Michael Rivkin, MD, have worked together with other members of the Center to study the role of the placenta in neonatal stroke.

Neurosurgeon Edward Smith, MD, is beginning to identify telltale proteins in the urine of patients with cerebrovascular disorders, such as moyamoya disease and arteriovenous malformations. These easy-to-measure “biomarkers” may help in diagnosing and monitoring CVD, reducing the need for children to visit the hospital for follow-up imaging studies.

Darren Orbach, MD, PhD, is conducting basic research around the development of a high-speed magnetic resonance (MR) technique for directly imaging rapid neuronal activity. The high-speed MR technique is currently being used to help further the understanding of the pathophysiology of various epilepsy syndromes.