Journal Article

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

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

2020

Overview

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.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Age / Aged / Angioplasty / Angioplasty - adverse effects / Angioplasty - methods / Atherosclerosis / Blood pressure / Body mass index / Cardiovascular disease / Cerebrovascular Disorders - diagnostic imaging / Cerebrovascular Disorders - mortality / Cerebrovascular Disorders - surgery / Cholesterol / Coronary vessels / Diabetes / Ethnicity / FDA approval / Female / Heart failure / Humans / Hypertension / Infections / Intracranial Arteriosclerosis - diagnostic imaging / Intracranial Arteriosclerosis - mortality / Intracranial Arteriosclerosis - surgery / Ischemic Stroke / Lipids / Male / Medical imaging / Medical treatment / Middle Aged / Mortality - trends / Patients / Postoperative Complications - diagnostic imaging / Postoperative Complications - etiology / Postoperative Complications - mortality / Risk Factors / Severity of Illness Index / stent / Stents / Stents - adverse effects / Stroke / Stroke - diagnostic imaging / Stroke - etiology / Stroke - mortality / Variables