Procedural factors associated with percutaneous coronary intervention-related ischemic stroke

Objectives: 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.