Document Detail


Procedural factors associated with percutaneous coronary intervention-related ischemic stroke.
MedLine Citation:
PMID:  22361605     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to determine whether procedural factors during percutaneous coronary intervention (PCI) are associated with the occurrence of ischemic stroke or transient ischemic attack (PCI-stroke).
BACKGROUND: Stroke is a devastating complication of PCI. Demographic predictors are nonmodifiable. Whether PCI-stroke is associated with procedural factors, which may be modifiable, is unknown.
METHODS: We performed a single-center retrospective study of 21,497 PCI hospitalizations between 1994 and 2008. We compared procedural factors from patients who suffered an ischemic stroke or transient ischemic attack related to PCI (n=79) and a control group (n=158), and matched them 2:1 based on a predicted probability of stroke developed from a logistic regression model.
RESULTS: PCI-stroke procedures involved the use of more catheters (median: 3 [quarter (Q) 1, Q3: 3, 4] vs. 3 [Q1, Q3: 2, 3], p<0.001), greater contrast volumes (250 ml vs. 218 ml, p=0.006), and larger guide caliber (median: 7-F [Q1, Q3: 6, 8] vs. 6-F [Q1, Q3: 6, 8], p<0.001). The number of lesions attempted (1.7±0.8 vs. 1.5±0.8, p=0.14) and stents placed (1.4±1.2 vs. 1.2±1.1, p=0.35) were similar between groups, but PCI-stroke patients were more likely to have undergone rotational atherectomy (10% vs. 3%, p=0.029). Overall procedural success was lower in the PCI-stroke group compared with controls (71% vs. 85%, p=0.017). Evaluation of the entire PCI population revealed no difference in the rate of PCI-stroke between radial and femoral approaches (0.4% vs. 0.4%, p=0.78).
CONCLUSIONS: Ischemic stroke related to PCI is associated with potentially modifiable technical parameters. Careful procedural planning is warranted, particularly in patients at increased risk.
Authors:
Scott J Hoffman; Helen C Routledge; Ryan J Lennon; Mohammad Z Mustafa; Charanjit S Rihal; Bernard J Gersh; David R Holmes; Rajiv Gulati
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  5     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-24     Completed Date:  2012-07-09     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  200-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / adverse effects*,  instrumentation,  methods
Coronary Artery Disease / therapy
Female
Great Britain / epidemiology
Humans
Logistic Models
Male
Registries
Retrospective Studies
Risk Assessment / methods
Statistics as Topic
Stroke / epidemiology,  etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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