title: Procedural factors associated with percutaneous coronary intervention-related ischemic stroke.
abstract: OBJECTIVE
  This study sought to determine whether procedural factors during percutaneous coronary intervention (PCI) are associated with the occurrence of ischemic stroke or transient ischemic attack (PCI-stroke).
  
  
  BACKGROUND
  Stroke is a devastating complication of PCI. Demographic predictors are nonmodifiable. Whether PCI-stroke is associated with procedural factors, which may be modifiable, is unknown.
  
  
  METHODS
  We performed a single-center retrospective study of 21,497 PCI hospitalizations between 1994 and 2008. We compared procedural factors from patients who suffered an ischemic stroke or transient ischemic attack related to PCI (n=79) and a control group (n=158), and matched them 2:1 based on a predicted probability of stroke developed from a logistic regression model.
  
  
  RESULTS
  PCI-stroke procedures involved the use of more catheters (median: 3 [quarter (Q) 1, Q3: 3, 4] vs. 3 [Q1, Q3: 2, 3], p<0.001), greater contrast volumes (250 ml vs. 218 ml, p=0.006), and larger guide caliber (median: 7-F [Q1, Q3: 6, 8] vs. 6-F [Q1, Q3: 6, 8], p<0.001). The number of lesions attempted (1.7±0.8 vs. 1.5±0.8, p=0.14) and stents placed (1.4±1.2 vs. 1.2±1.1, p=0.35) were similar between groups, but PCI-stroke patients were more likely to have undergone rotational atherectomy (10% vs. 3%, p=0.029). Overall procedural success was lower in the PCI-stroke group compared with controls (71% vs. 85%, p=0.017). Evaluation of the entire PCI population revealed no difference in the rate of PCI-stroke between radial and femoral approaches (0.4% vs. 0.4%, p=0.78).
  
  
  CONCLUSIONS
  Ischemic stroke related to PCI is associated with potentially modifiable technical parameters. Careful procedural planning is warranted, particularly in patients at increased risk.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Hoffman
authors.forename: Helen C
authors.initials: HC
authors.lastname: Routledge
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Mohammad Z
authors.initials: MZ
authors.lastname: Mustafa
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D003324:Coronary Artery Disease / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013223:Statistics as Topic; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D006113:United Kingdom / Q000453:epidemiology