Procedural Factors Associated With Percutaneous Coronary Intervention-Related Ischemic Stroke

Hoffman, Scott J.; Routledge, Helen; Lennon, Ryan J.; Mustafa, Mohammad Z.; Rihal, Charanjit S.; Gersh, Bernard J.; Holmes, David R.; Gulati, Rajiv

doi:10.1016/j.jcin.2011.10.014

Cited by 69 publications

(41 citation statements)

References 22 publications

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“…This may be partially due to selection bias because MRI was performed in candidates for cardiac surgery for atherosclerotic disease. The rate of catheterization-related symptomatic ischemic stroke recorded in this study (0.24%) is roughly equivalent to those reported in previous studies [1][2][3][4][5][6][7][8][9].…”

Section: A Single Center Retrospective Analysis Of Catheterization-resupporting

confidence: 87%

See 1 more Smart Citation

Hypercholesterolemia as a Risk Factor for Catheterization- Related Cerebral Infarction — A Literature Review and a Summary of Cases

Morita¹,

Kato²,

Inoko³

2015

Hypercholesterolemia

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Section: A Single Center Retrospective Analysis Of Catheterization-resupporting

confidence: 87%

“…Previous studies reported stroke rates of 0.1-0.4% [1][2][3][4][5][6][7][8][9]. Catheterization-related acute stroke is associated with high in-hospital mortality and prevalence of overall major complications [5,10,11].…”

Section: Introductionmentioning

confidence: 99%

Hypercholesterolemia as a Risk Factor for Catheterization- Related Cerebral Infarction — A Literature Review and a Summary of Cases

Morita¹,

Kato²,

Inoko³

2015

Hypercholesterolemia

View full text Add to dashboard Cite

“…Explanations could be a more severe vascular calcification in patients presenting with an ACS and a longer duration of the catheterization procedure during urgent or even emergency situations with possibly less careful advancement of catheters through the aorta under pressure of time, which is associated with an increased risk of cerebral embolization by scraping at aortic plaques. 9,22 Differences in plaque composition in ACS versus stable patients leading to an increased chance to cause embolism could also be 1 explanation for the findings. The possibility for hemodynamic compromise is also higher in patients with an ACS, which is known to increase the risk for intracardial thrombus formation and the risk for stroke.…”

Section: Discussionmentioning

confidence: 94%

“…Interventions at bypass grafts are usually technically more challenging, showing longer fluoroscopy times and, therefore, potentially leading to a higher risk of cerebral microembolism. 22 Especially in PCIs of internal mammary artery bypass grafts, which need to be intubated via the subclavian artery lying close to the internal carotid or vertebral artery, the risk of scraping at atherosclerotic plaques increases, potentially leading to a higher rate of cerebral embolism.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Impact of Stroke Complicating Percutaneous Coronary Intervention

Werner

Bauer

Hochadel

et al. 2013

Circ: Cardiovascular Interventions

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Background-Stroke is a rare but serious complication of percutaneous coronary interventions (PCIsIn multivariate analysis hemodynamic instability, age ≥75 years, history of stroke, and congestive heart failure were found to be independent predictors for periprocedural stroke in ACS, whereas only PCI of a bypass graft and renal failure could be identified as independent predictors for stroke in elective patients. Conclusions-Stroke as complication of PCI occurs rarely (0.4%) in clinical practice in Europe today. However, periinterventional stroke is still associated with an exceedingly high in-hospital mortality rate. Most predictors for periprocedural stroke are not modifiable and cannot be diminished before PCI. Therefore, treatment of patients with stroke after PCI needs further research. (Circ Cardiovasc Interv. 2013;6:362-369.)

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“…We and others have previously shown that it is associated with high in-hospital mortality [1][2][3][4] and causes life-changing disabilities in those who survive. [5][6][7] Previous studies were conducted in both single-centre 8,9 and multicentre settings 1,2 and reported the incidence, major determinants and outcomes of stroke after PCI.…”

mentioning

confidence: 99%

Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication

Myint

Kwok

Roffe

et al. 2016

Stroke

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Background and Purpose-Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented. Methods-The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization). Results-A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively. Conclusions-Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.

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Procedural Factors Associated With Percutaneous Coronary Intervention-Related Ischemic Stroke

Abstract: Ischemic stroke related to PCI is associated with potentially modifiable technical parameters. Careful procedural planning is warranted, particularly in patients at increased risk.

Cited by 69 publications

References 22 publications

Hypercholesterolemia as a Risk Factor for Catheterization- Related Cerebral Infarction — A Literature Review and a Summary of Cases

Hypercholesterolemia as a Risk Factor for Catheterization- Related Cerebral Infarction — A Literature Review and a Summary of Cases

Incidence and Clinical Impact of Stroke Complicating Percutaneous Coronary Intervention

Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication

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