Faculty Collaboration Database

Risk factors associated with major cerebrovascular complications after intracranial stenting. Neurology 2009 Jun 09;72(23):2014-9

Date

03/21/2009

Pubmed ID

19299309

Pubmed Central ID

PMC2837590

DOI

10.1212/01.wnl.0b013e3181a1863c

Scopus ID

2-s2.0-67649472551 (requires institutional sign-in at Scopus site)   107 Citations

Abstract

BACKGROUND: There are limited data on the relationship between patient and site characteristics and clinical outcomes after intracranial stenting.

METHODS: We performed a multivariable analysis that correlated patient and site characteristics with the occurrence of the primary endpoint (any stroke or death within 30 days of stenting or stroke in the territory of the stented artery beyond 30 days) in 160 patients enrolled in this stenting registry. All patients presented with an ischemic stroke, TIA, or other cerebral ischemic event (e.g., vertebrobasilar insufficiency) in the territory of a suspected 50-99% stenosis of a major intracranial artery while on antithrombotic therapy.

RESULTS: Cerebral angiography confirmed that 99% (158/160) of patients had a 50-99% stenosis. In multivariable analysis, the primary endpoint was associated with posterior circulation stenosis (vs anterior circulation) (hazard ratio [HR] 3.4, 95% confidence interval [CI] 1.2-9.3, p = 0.018), stenting at low enrollment sites (< 10 patients each) (vs high enrollment site) (HR 2.8, 95% CI 1.1-7.6, p = 0.038), < or = 10 days from qualifying event to stenting (vs > or = 10 days) (HR 2.7, 95% CI 1.0-7.8, p = 0.058), and stroke as a qualifying event (vs TIA/other) (HR 3.2, 95% CI 0.9-11.2, p = 0.064). There was no significant difference in the primary endpoint based on age, gender, race, or percent stenosis (50-69% vs 70-99%).

CONCLUSIONS: Major cerebrovascular complications after intracranial stenting may be associated with posterior circulation stenosis, low volume sites, stenting soon after a qualifying event, and stroke as the qualifying event. These factors will need to be monitored in future trials of intracranial stenting.

Author List

Nahab F, Lynn MJ, Kasner SE, Alexander MJ, Klucznik R, Zaidat OO, Chaloupka J, Lutsep H, Barnwell S, Mawad M, Lane B, Chimowitz MI, NIH Multicenter Wingspan Intracranial Stent Registry Study Group

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Aged
Brain Infarction
Endpoint Determination
Female
Humans
Intracranial Thrombosis
Male
Middle Aged
Platelet Aggregation Inhibitors
Postoperative Complications
Professional Competence
Registries
Retrospective Studies
Risk Factors
Stents
Stroke
Vascular Surgical Procedures
Vertebrobasilar Insufficiency