Journal article
Detailed Analysis of Periprocedural Strokes in Patients Undergoing Intracranial Stenting in Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS)
Stroke (1970), Vol.43(10), pp.2682-2688
2012
DOI: 10.1161/STROKEAHA.112.661173
PMID: 22984008
Abstract
Background and Purpose—
Enrollment in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial was halted due to the high risk of stroke or death within 30 days of enrollment in the percutaneous transluminal angioplasty and stenting arm relative to the medical arm. This analysis focuses on the patient and procedural factors that may have been associated with periprocedural cerebrovascular events in the trial.
Methods—
Bivariate and multivariate analyses were performed to evaluate whether patient and procedural variables were associated with cerebral ischemic or hemorrhagic events occurring within 30 days of enrollment (termed periprocedural) in the percutaneous transluminal angioplasty and stenting arm.
Results—
Of 224 patients randomized to percutaneous transluminal angioplasty and stenting, 213 underwent angioplasty alone (n=5) or with stenting (n=208). Of these, 13 had hemorrhagic strokes (7 parenchymal, 6 subarachnoid), 19 had ischemic stroke, and 2 had cerebral infarcts with temporary signs within the periprocedural period. Ischemic events were categorized as perforator occlusions (13), embolic (4), mixed perforator and embolic (2), and delayed stent occlusion (2). Multivariate analyses showed that higher percent stenosis, lower modified Rankin score, and clopidogrel load associated with an activated clotting time above the target range were associated (P≤0.05) with hemorrhagic stroke. Nonsmoking, basilar artery stenosis, diabetes, and older age were associated (P≤0.05) with ischemic events.
Conclusions—
Periprocedural strokes in SAMMPRIS had multiple causes with the most common being perforator occlusion. Although risk factors for periprocedural strokes could be identified, excluding patients with these features from undergoing percutaneous transluminal angioplasty and stenting to lower the procedural risk would limit percutaneous transluminal angioplasty and stenting to a small subset of patients. Moreover, given the small number of events, the present data should be used for hypothesis generation rather than to guide patient selection in clinical practice.
Details
- Title: Subtitle
- Detailed Analysis of Periprocedural Strokes in Patients Undergoing Intracranial Stenting in Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS)
- Creators
- David FIORELLA - Department of Neurosurgery, State University of New York, Stony Brook, NY, United StatesColin P DERDEYN - Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery, Washington University School of Medicine, St Louis, MO, United StatesOsama O ZAIDAT - Departments of Neurology, Radiology, and Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United StatesHelmi L LUTSEP - Department of Neurology Oregon Health Sciences University, Portland, OR, United StatesMichael F WATERS - Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, United StatesJ Maurice Hourihane - Dent Neurological Institute, Buffalo, NY, United StatesAndrei V ALEXANDROV - Department of Neurology, University of Alabama, Birmingham, AL, United StatesDavid CHIU - Department of Neurology, The Methodist Hospital, Houston, TX, United StatesJoni M CLARK - Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United StatesMark D JOHNSON - Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, United StatesMichel T TORBEY - Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United StatesZoran RUMBOLDT - Department of Radiology, Medical University of South Carolina, Charleston, SC, United StatesMichael J LYNN - Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, United StatesHarry J CLOFT - Department of Radiology, Mayo Clinic, Rochester, MN, United StatesTanya N TURAN - Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United StatesBethany F LANE - Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, United StatesL Scott Janis - National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, United StatesMarc I CHIMOWITZ - Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United StatesStanley L BARNWELL - Department of Neurological Surgery and the Dotter Interventional Institute, United StatesBrian L HOH - Department of Neurosurgery, University of Florida, Gainesville, FL, United StatesElad I LEVY - Department of Neurosurgery, University of Buffalo, Buffalo, NY, United StatesMark R HARRIGAN - Department of Neurosurgery, University of Alabama, Birmingham, AL, United StatesRichard P KLUCZNIK - Department of Radiology, The Methodist Hospital, Houston, TX, United StatesCameron G MCDOUGALL - Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United StatesG Lee Pride - Departments of Radiology and Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.43(10), pp.2682-2688
- Publisher
- Lippincott Williams & Wilkins; Hagerstown, MD
- DOI
- 10.1161/STROKEAHA.112.661173
- PMID
- 22984008
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 2012
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020769702771
Metrics
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