Abstract 11124: Procedural Factors Associated with Percutaneous Coronary Intervention-Related Ischemic Stroke
Aims We sought to determine procedural factors associated with the occurrence of ischemic stroke related to percutaneous coronary intervention (PCI).
Methods and results: We performed a retrospective study of 21,502 PCI hospitalizations in 17,249 unique patients between 1994 and 2008 at a single center. We identified 79 patients who suffered a non-hemorrhagic stroke or TIA related to PCI (PCI-stroke). We compared procedural factors in patients who suffered a PCI-stroke with a control group (n=156). Controls were matched at a 2-to-1 ratio, matching being based on the predicted probability of stroke developed from a logistic regression model. There were no significant differences in demographic and angiographic characteristics between PCI-stroke patients and controls. However, PCI procedures resulting in stroke involved significantly more catheter exchanges [median 3 (Q1, Q3: 3, 4) vs 3 (2, 3), p < 0.001)], greater contrast volumes [250 mL vs 218 mL, p = 0.006], and a trend toward usage of larger caliber guiding catheters [median 7.0 Fr (6, 8) vs 6.0 Fr (6, 8), p = 0.15]. There was no significant difference in the rate of ischemic stroke between radial and femoral approaches [0.57% vs 0.34%, p = 0.32]. Although the number of lesions attempted (mean ± SD: 1.7 ± 0.8 vs 1.5 ±0.8, p=0.14) and stents placed (1.4 ± 1.2 vs 1.3 ± 1.0, p=0.39) were similar between groups, PCI-stroke patients had significantly more unsuccessful lesion attempts [16% vs 6%, p = 0.017] and were more likely to have undergone rotational atherectomy [10% vs 3%, p = 0.029] compared with controls.
Conclusion: PCI -related ischemic stroke is associated with parameters of procedural complexity, more frequent catheter exchanges and more unsuccessful lesion attempts compared with non-stroke controls.
- © 2010 by American Heart Association, Inc.