Peri-procedural stroke or death in stenting of symptomatic severe intracranial stenosis

Abstract

Background and purposeThere are limited data on predictors of 30-day stroke or death in patients with symptomatic intracranial atherosclerosis (sICAS) undergoing stenting. We aim to determine the factors associated with stroke or death at 30 days in the stenting arm of the SAMMPRIS trial.MethodsThis is a post-hoc analysis of the SAMMPRIS trial including patients who underwent angioplasty/stenting. We compared patient-specific variables, lesion-specific variables, procedure-specific variables, and FDA-approved indications between patients with and without the primary outcome (stroke or death at 30 days). Logistic regression analyses were performed to evaluate associations with the primary outcome.ResultsWe identified 213 patients, 30 of whom (14.1%) met the primary outcome. Smoking status and lesion length were associated with the primary outcome: the odds of stroke or death for non-smokers versus smokers (adjusted OR 4.46, 95% CI 1.79 to 11.1, p=0.001) and for increasing lesion length in millimeters (adjusted OR 1.20, 95% CI 1.02 to 1.39, p=0.029). These had a modest predictive value: absence of smoking history (sensitivity 66.7%, specificity 65.4%) and lesion length (area under curve 0.606). Furthermore, event rates were not significantly different between patients with and without the FDA-approved indication for stenting (15.9% vs 12%, p=0.437).ConclusionIn SAMMPRIS patients who underwent angioplasty/stenting, neither clinical and neuroimaging variables nor the FDA indication for stenting reliably predicted the primary outcome. Further work in identifying reliable biomarkers of stroke/death in patients with sICAS is needed before considering new clinical trials of stenting.Trial registration numberSAMMPRIS NCT00576693; Results.

Intracranial Angioplasty with Enterprise Stent for Intracranial Atherosclerotic Stenosis: A Single-Center Experience and a Systematic Review

“…The open-cell design of the Neuroform EZ stent was thought to be associated with this result [18]. However, the exact risk factors for these perioperative complications after PTAS with the Enterprise stent are still uncertain, and further research is needed [37]. In particular, for high-grade stenosis, the low complication rate in our study supported the safety of Enterprise stent implantation in ICAS treatment.…”

Endovascular Treatment of Large Vessel Occlusion Strokes Due to Intracranial Atherosclerotic Disease

“…In a post hoc analysis from the SAMMPRIS trial, lesion length was an independent predictor of 30-day stroke or mortality in patients undergoing angioplasty and stenting. 77 Likewise, pretreatment stenotic degree has been established as a strong predictor for in stent restenosis. 78,79 Therefore, the combination of severe stenosis and long plaque length represents a significant challenge.…”

Factors Influencing the Outcome of Symptomatic Intracranial Artery Stenosis With Hemodynamic Impairment After Short and Long-Term Stent Placement

“…We performed a filter on the variables described above based on the univariate analysis results (variables with P ≤ 0.200) and on clinical experience and previous results observed in similar published reports ( 16 , 17 ) for the multivariate analysis. The significant factors are showed in Table 1 .…”

“…Conversely, greater stenosis, low mRS scores, and clopidogrel loading increased the risk for hemorrhagic stroke ( 16 ). When stroke and death were defined as a combined endpoint for analysis, only nonsmoking and longer lesions were associated with increased risk, but did not exhibit good predictive values ( 17 ). Our findings revealed that lesions located at arterial origins or bifurcations exhibited a higher short-term postoperative risk.…”

“…The inclusion criteria for variables in the multivariate analysis were as follows. (1) A p-value that was 0.200 or less in the univariate analysis of each variable(2) The covariates were screened based on clinical experience and previous results reported in similar published studies ( 16 , 17 ). The backward elimination method was used to filter the variables and establish the final model.…”