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Ischemic Stroke
Original research
Peri-procedural stroke or death in stenting of symptomatic severe intracranial stenosis
  1. Shadi Yaghi1,
  2. Pooja Khatri2,
  3. Adam de Havenon3,
  4. Sharon Yeatts4,
  5. Andrew D Chang5,
  6. Shawna Cutting5,
  7. Brian Mac Grory5,
  8. Tina Burton5,
  9. Mahesh V Jayaraman6,
  10. Ryan A McTaggart7,8,
  11. David Fiorella9,10,
  12. Colin Derdeyn11,
  13. Osama O Zaidat12,
  14. Seena Dehkharghani13,
  15. Sepideh Amin-Hanjani14,
  16. Karen Furie15,
  17. Shyam Prahbakaran16,
  18. David Liebeskind17
  1. 1 Department of Neurology, New York Langone Health, New York, NY, USA
  2. 2 Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
  3. 3 Department of Neurology, University of Utah, Salt Lake City, Utah, USA
  4. 4 Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA
  5. 5 Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  6. 6 Department of Diagnostic Imaging, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  7. 7 Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
  8. 8 Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  9. 9 Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  10. 10 Diagnostic Radiology, SUNY SB, Stony Brook, New York, USA
  11. 11 Department of Radiology and Interventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  12. 12 Department of Neuroscience, St Vincent Mercy Hospital, Toledo, Ohio, USA
  13. 13 NYU Langone Health, New York, New York, USA
  14. 14 Neurosurgery, University of Illinois, Chicago, Illinois, USA
  15. 15 Department of Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
  16. 16 Neurology, University of Chicago, Chicago, Illinois, USA
  17. 17 Department of Neurology, UCLA, Los Angeles, California, USA
  1. Correspondence to Dr Shadi Yaghi, Neurology, UAMS, Little Rock, AR 72205, USA; shadiyaghi{at}yahoo.com

Abstract

Background and purpose 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.

Methods 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.

Results 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).

Conclusion 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.

Trial registration number SAMMPRIS NCT00576693; Results.

  • stroke
  • atherosclerosis
  • stent
  • angioplasty

https://doi.org/10.1136/neurintsurg-2019-015225

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    Footnotes

    • Contributors All authors contributed to this manuscript.

    • Funding This study was funded by the National Institute of Neurological Disorder and Stroke (NINDS) and the grant number is R01NS058728-01A1.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data from this study are publicly available upon request and approval from the NINDS.

    • Correction notice Since this article was first published online, the author name Sam Zaidat has been updated to Osama O Zaidat.

    • Patient consent for publication Not required.