Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms

Results from the Intre PED study

Waleed Brinjikji, G. Lanzino, H. J. Cloft, A. H. Siddiqui, E. Boccardi, S. Cekirge, D. Fiorella, R. Hanel, P. Jabbour, E. Levy, D. Lopes, P. Lylyk, I. Szikora, David F Kallmes

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: Risk factors for acute ischemic stroke following flow-diverter treatment of intracranial aneurysms are poorly understood. Using the International Retrospective Study of Pipeline Embolization Device (IntrePED) registry, we studied demographic, aneurysm, and procedural characteristics associated with postoperative acute ischemic stroke following Pipeline Embolization Device (PED) treatment. MATERIALS AND METHODS: We identified patients in the IntrePED registry with post-PED-treatment acute ischemic stroke. The rate of postoperative acute ischemic stroke was determined by demographics, comorbidities, aneurysm characteristics, and procedure characteristics (including anticoagulation use, platelet testing, number of devices used, sheaths, and so forth). Categoric variables were compared with x2 testing, and continuous variables were compared with the Student t test. Odds ratios and 95% confidence intervals were obtained by using univariate logistic regression. Multivariate logistic regression analysis was used to determine which factors were independently associated with postoperative stroke. RESULTS: Of 793 patients with 906 aneurysms, 36 (4.5%) patients had acute ischemic stroke. Twenty-si(72.2%) strokes occurred within 30 days of treatment (median, 3.5 days; range, 0-397 days). Ten patients died, and the remaining 26 had major neurologic morbidity. Variables associated with higher odds of acute ischemic stroke on univariate analysis included male sex, hypertension, treatment ofMCAaneurysms, treatment of fusiform aneurysms, treatment of giant aneurysms, and use of multiple PEDs. However, on multivariate analysis, the only one of these variables independently associated with stroke was treatment of fusiform aneurysms (OR, 2.74; 95% CI, 1.11- 6.75; P=.03). Fusiform aneurysms that were associated with stroke were significantly larger than those not associated with stroke (mean, 24.5 ± 12.5 mm versus 13.6 ^plusmn; 6.8 mm; P < .001). CONCLUSIONS: Ischemic stroke following PED treatment is an uncommon-but-devastating complication. Fusiform aneurysms were the only variable independently associated with postoperative stroke.

Original languageEnglish (US)
Pages (from-to)1673-1678
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume37
Issue number9
DOIs
StatePublished - Sep 1 2016

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Intracranial Aneurysm
Stroke
Equipment and Supplies
Aneurysm
Therapeutics
Registries
Retrospective Studies
Logistic Models
Demography
Platelet Count
Nervous System
Comorbidity
Multivariate Analysis
Odds Ratio
Regression Analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms : Results from the Intre PED study. / Brinjikji, Waleed; Lanzino, G.; Cloft, H. J.; Siddiqui, A. H.; Boccardi, E.; Cekirge, S.; Fiorella, D.; Hanel, R.; Jabbour, P.; Levy, E.; Lopes, D.; Lylyk, P.; Szikora, I.; Kallmes, David F.

In: American Journal of Neuroradiology, Vol. 37, No. 9, 01.09.2016, p. 1673-1678.

Research output: Contribution to journalArticle

Brinjikji, W, Lanzino, G, Cloft, HJ, Siddiqui, AH, Boccardi, E, Cekirge, S, Fiorella, D, Hanel, R, Jabbour, P, Levy, E, Lopes, D, Lylyk, P, Szikora, I & Kallmes, DF 2016, 'Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms: Results from the Intre PED study', American Journal of Neuroradiology, vol. 37, no. 9, pp. 1673-1678. https://doi.org/10.3174/ajnr.A4807
Brinjikji, Waleed ; Lanzino, G. ; Cloft, H. J. ; Siddiqui, A. H. ; Boccardi, E. ; Cekirge, S. ; Fiorella, D. ; Hanel, R. ; Jabbour, P. ; Levy, E. ; Lopes, D. ; Lylyk, P. ; Szikora, I. ; Kallmes, David F. / Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms : Results from the Intre PED study. In: American Journal of Neuroradiology. 2016 ; Vol. 37, No. 9. pp. 1673-1678.
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title = "Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms: Results from the Intre PED study",
abstract = "BACKGROUND AND PURPOSE: Risk factors for acute ischemic stroke following flow-diverter treatment of intracranial aneurysms are poorly understood. Using the International Retrospective Study of Pipeline Embolization Device (IntrePED) registry, we studied demographic, aneurysm, and procedural characteristics associated with postoperative acute ischemic stroke following Pipeline Embolization Device (PED) treatment. MATERIALS AND METHODS: We identified patients in the IntrePED registry with post-PED-treatment acute ischemic stroke. The rate of postoperative acute ischemic stroke was determined by demographics, comorbidities, aneurysm characteristics, and procedure characteristics (including anticoagulation use, platelet testing, number of devices used, sheaths, and so forth). Categoric variables were compared with x2 testing, and continuous variables were compared with the Student t test. Odds ratios and 95{\%} confidence intervals were obtained by using univariate logistic regression. Multivariate logistic regression analysis was used to determine which factors were independently associated with postoperative stroke. RESULTS: Of 793 patients with 906 aneurysms, 36 (4.5{\%}) patients had acute ischemic stroke. Twenty-si(72.2{\%}) strokes occurred within 30 days of treatment (median, 3.5 days; range, 0-397 days). Ten patients died, and the remaining 26 had major neurologic morbidity. Variables associated with higher odds of acute ischemic stroke on univariate analysis included male sex, hypertension, treatment ofMCAaneurysms, treatment of fusiform aneurysms, treatment of giant aneurysms, and use of multiple PEDs. However, on multivariate analysis, the only one of these variables independently associated with stroke was treatment of fusiform aneurysms (OR, 2.74; 95{\%} CI, 1.11- 6.75; P=.03). Fusiform aneurysms that were associated with stroke were significantly larger than those not associated with stroke (mean, 24.5 ± 12.5 mm versus 13.6 ^plusmn; 6.8 mm; P < .001). CONCLUSIONS: Ischemic stroke following PED treatment is an uncommon-but-devastating complication. Fusiform aneurysms were the only variable independently associated with postoperative stroke.",
author = "Waleed Brinjikji and G. Lanzino and Cloft, {H. J.} and Siddiqui, {A. H.} and E. Boccardi and S. Cekirge and D. Fiorella and R. Hanel and P. Jabbour and E. Levy and D. Lopes and P. Lylyk and I. Szikora and Kallmes, {David F}",
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T2 - Results from the Intre PED study

AU - Brinjikji, Waleed

AU - Lanzino, G.

AU - Cloft, H. J.

AU - Siddiqui, A. H.

AU - Boccardi, E.

AU - Cekirge, S.

AU - Fiorella, D.

AU - Hanel, R.

AU - Jabbour, P.

AU - Levy, E.

AU - Lopes, D.

AU - Lylyk, P.

AU - Szikora, I.

AU - Kallmes, David F

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N2 - BACKGROUND AND PURPOSE: Risk factors for acute ischemic stroke following flow-diverter treatment of intracranial aneurysms are poorly understood. Using the International Retrospective Study of Pipeline Embolization Device (IntrePED) registry, we studied demographic, aneurysm, and procedural characteristics associated with postoperative acute ischemic stroke following Pipeline Embolization Device (PED) treatment. MATERIALS AND METHODS: We identified patients in the IntrePED registry with post-PED-treatment acute ischemic stroke. The rate of postoperative acute ischemic stroke was determined by demographics, comorbidities, aneurysm characteristics, and procedure characteristics (including anticoagulation use, platelet testing, number of devices used, sheaths, and so forth). Categoric variables were compared with x2 testing, and continuous variables were compared with the Student t test. Odds ratios and 95% confidence intervals were obtained by using univariate logistic regression. Multivariate logistic regression analysis was used to determine which factors were independently associated with postoperative stroke. RESULTS: Of 793 patients with 906 aneurysms, 36 (4.5%) patients had acute ischemic stroke. Twenty-si(72.2%) strokes occurred within 30 days of treatment (median, 3.5 days; range, 0-397 days). Ten patients died, and the remaining 26 had major neurologic morbidity. Variables associated with higher odds of acute ischemic stroke on univariate analysis included male sex, hypertension, treatment ofMCAaneurysms, treatment of fusiform aneurysms, treatment of giant aneurysms, and use of multiple PEDs. However, on multivariate analysis, the only one of these variables independently associated with stroke was treatment of fusiform aneurysms (OR, 2.74; 95% CI, 1.11- 6.75; P=.03). Fusiform aneurysms that were associated with stroke were significantly larger than those not associated with stroke (mean, 24.5 ± 12.5 mm versus 13.6 ^plusmn; 6.8 mm; P < .001). CONCLUSIONS: Ischemic stroke following PED treatment is an uncommon-but-devastating complication. Fusiform aneurysms were the only variable independently associated with postoperative stroke.

AB - BACKGROUND AND PURPOSE: Risk factors for acute ischemic stroke following flow-diverter treatment of intracranial aneurysms are poorly understood. Using the International Retrospective Study of Pipeline Embolization Device (IntrePED) registry, we studied demographic, aneurysm, and procedural characteristics associated with postoperative acute ischemic stroke following Pipeline Embolization Device (PED) treatment. MATERIALS AND METHODS: We identified patients in the IntrePED registry with post-PED-treatment acute ischemic stroke. The rate of postoperative acute ischemic stroke was determined by demographics, comorbidities, aneurysm characteristics, and procedure characteristics (including anticoagulation use, platelet testing, number of devices used, sheaths, and so forth). Categoric variables were compared with x2 testing, and continuous variables were compared with the Student t test. Odds ratios and 95% confidence intervals were obtained by using univariate logistic regression. Multivariate logistic regression analysis was used to determine which factors were independently associated with postoperative stroke. RESULTS: Of 793 patients with 906 aneurysms, 36 (4.5%) patients had acute ischemic stroke. Twenty-si(72.2%) strokes occurred within 30 days of treatment (median, 3.5 days; range, 0-397 days). Ten patients died, and the remaining 26 had major neurologic morbidity. Variables associated with higher odds of acute ischemic stroke on univariate analysis included male sex, hypertension, treatment ofMCAaneurysms, treatment of fusiform aneurysms, treatment of giant aneurysms, and use of multiple PEDs. However, on multivariate analysis, the only one of these variables independently associated with stroke was treatment of fusiform aneurysms (OR, 2.74; 95% CI, 1.11- 6.75; P=.03). Fusiform aneurysms that were associated with stroke were significantly larger than those not associated with stroke (mean, 24.5 ± 12.5 mm versus 13.6 ^plusmn; 6.8 mm; P < .001). CONCLUSIONS: Ischemic stroke following PED treatment is an uncommon-but-devastating complication. Fusiform aneurysms were the only variable independently associated with postoperative stroke.

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