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

Shadi Yaghi; Pooja Khatri; Adam de Havenon; Sharon Yeatts; Andrew D Chang; Shawna Cutting; Brian Mac Grory; Tina Burton; Mahesh V Jayaraman; Ryan A McTaggart; David Fiorella; Colin Derdeyn; Osama O Zaidat; Seena Dehkharghani; Sepideh Amin-Hanjani; Karen Furie; Shyam Prahbakaran; David Liebeskind

doi:10.1136/neurintsurg-2019-015225

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

Journal article

Peer reviewed

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

Shadi Yaghi, Pooja Khatri, Adam de Havenon, Sharon Yeatts, Andrew D Chang, Shawna Cutting, Brian Mac Grory, Tina Burton, Mahesh V Jayaraman, Ryan A McTaggart, …

Journal of neurointerventional surgery, Vol.12(4), pp.374-379

04/2020

DOI: 10.1136/neurintsurg-2019-015225

PMCID: PMC8022354

PMID: 31484697

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https://www.ncbi.nlm.nih.gov/pmc/articles/8022354View

Open Access

Abstract

There 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. This 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. We 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). In 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. SAMMPRIS NCT00576693; Results.

Severity of Illness Index

Postoperative Complications - etiology

Stroke - diagnostic imaging

Humans

Middle Aged

Risk Factors

Male

Angioplasty - methods

Mortality - trends

Postoperative Complications - mortality

Intracranial Arteriosclerosis - mortality

Cerebrovascular Disorders - mortality

Stroke - etiology

Angioplasty - adverse effects

Intracranial Arteriosclerosis - surgery

Cerebrovascular Disorders - diagnostic imaging

Cerebrovascular Disorders - surgery

Female

Aged

Stroke - mortality

Intracranial Arteriosclerosis - diagnostic imaging

Stents - adverse effects

Postoperative Complications - diagnostic imaging

Details

Title: Subtitle: Peri-procedural stroke or death in stenting of symptomatic severe intracranial stenosis
Creators: Shadi Yaghi - Department of Neurology, New York Langone Health, New York, NY, USA
Pooja Khatri - Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
Adam de Havenon - Department of Neurology, University of Utah, Salt Lake City, Utah, USA
Sharon Yeatts - Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA
Andrew D Chang - Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
Shawna Cutting - Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
Brian Mac Grory - Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
Tina Burton - Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
Mahesh V Jayaraman - Department of Diagnostic Imaging, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
Ryan A McTaggart - Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
David Fiorella - Diagnostic Radiology, SUNY SB, Stony Brook, New York, USA
Colin Derdeyn - Department of Radiology and Interventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Osama O Zaidat - Department of Neuroscience, St Vincent Mercy Hospital, Toledo, Ohio, USA
Seena Dehkharghani - NYU Langone Health, New York, New York, USA
Sepideh Amin-Hanjani - Neurosurgery, University of Illinois, Chicago, Illinois, USA
Karen Furie - Department of Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
Shyam Prahbakaran - Neurology, University of Chicago, Chicago, Illinois, USA
David Liebeskind - Department of Neurology, UCLA, Los Angeles, California, USA
Resource Type: Journal article
Publication Details: Journal of neurointerventional surgery, Vol.12(4), pp.374-379
DOI: 10.1136/neurintsurg-2019-015225
PMID: 31484697
PMCID: PMC8022354
NLM abbreviation: J Neurointerv Surg
ISSN: 1759-8478
eISSN: 1759-8486
Publisher: England
Grant note: U01 NS058728 / NINDS NIH HHS K23 NS105924 / NINDS NIH HHS
Language: English
Date published: 04/2020
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984070278602771

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