title: Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention.
abstract: OBJECTIVE
  We sought to determine neuroimaging patterns, ischemic mechanisms, and functional outcomes of ischemic stroke related to percutaneous coronary intervention (PCI) over a 16-year period.
  
  
  BACKGROUND
  Stroke is a feared complication of PCI, associated with poor patient outcomes. The majority of strokes that occur after PCI are ischemic rather than hemorrhagic. However, mechanisms of cerebral ischemia in this setting are incompletely understood.
  
  
  METHODS
  We performed a retrospective single-center cohort study of patients with radiologically confirmed ischemic stroke occurring after PCI (PCI-stroke), between January 1, 1994 and December 31, 2009. Using brain imaging, infarctions were subclassified by radiological pattern and arterial territory as embolic, small subcortical, or hemodynamic. Modified Rankin Scale scores were used to assess functional outcome at 3 and 6 months.
  
  
  RESULTS
  Radiologically confirmed PCI-stroke was identified in 35 patients. The majority of strokes (91%) revealed an embolic pattern, while the remaining strokes were small subcortical infarctions (9%). Watershed strokes with exclusive borderzone involvement, indicative of a hemodynamic mechanism, were not identified, despite the presence of periprocedural hypotension in 23% of patients. The middle cerebral artery (MCA) territory was affected most frequently (80%), and all patients suffering a complete MCA territorial infarction (14%) died in the hospital. Functional outcome among survivors of PCI-stroke was typically favorable in those who had single rather than multiple vascular territory involvement.
  
  
  CONCLUSIONS
  The vast majority of radiologically confirmed ischemic strokes related to PCI are embolic. MCA territory strokes are most common and uniformly fatal when the entire MCA territory is affected. Functional outcomes in survivors of PCI-stroke are improved when only a single arterial territory is affected.
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Hoffman
authors.forename: Alan H
authors.initials: AH
authors.lastname: Yee
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Slusser
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: PCI complications; percutaneous coronary intervention; stroke