Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention

Scott J. Hoffman, Alan Howe Yee, Joshua P. Slusser, Charanjit S. Rihal, David R. Holmes, Alejandro A. Rabinstein, Rajiv Gulati

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives 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.

Original languageEnglish (US)
Pages (from-to)1033-1040
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number6
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Neuroimaging
Stroke
Middle Cerebral Artery Infarction
Middle Cerebral Artery
Survivors
Hemodynamics
Brain Infarction
Cerebral Infarction
Brain Ischemia
Hypotension
Blood Vessels
Cohort Studies

Keywords

  • PCI complications
  • percutaneous coronary intervention
  • stroke

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Hoffman, S. J., Yee, A. H., Slusser, J. P., Rihal, C. S., Holmes, D. R., Rabinstein, A. A., & Gulati, R. (2015). Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention. Catheterization and Cardiovascular Interventions, 85(6), 1033-1040. https://doi.org/10.1002/ccd.25678

Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention. / Hoffman, Scott J.; Yee, Alan Howe; Slusser, Joshua P.; Rihal, Charanjit S.; Holmes, David R.; Rabinstein, Alejandro A.; Gulati, Rajiv.

In: Catheterization and Cardiovascular Interventions, Vol. 85, No. 6, 01.01.2015, p. 1033-1040.

Research output: Contribution to journalArticle

Hoffman, SJ, Yee, AH, Slusser, JP, Rihal, CS, Holmes, DR, Rabinstein, AA & Gulati, R 2015, 'Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention', Catheterization and Cardiovascular Interventions, vol. 85, no. 6, pp. 1033-1040. https://doi.org/10.1002/ccd.25678
Hoffman, Scott J. ; Yee, Alan Howe ; Slusser, Joshua P. ; Rihal, Charanjit S. ; Holmes, David R. ; Rabinstein, Alejandro A. ; Gulati, Rajiv. / Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 85, No. 6. pp. 1033-1040.
@article{37e379d8651c4b70ab6d078b3a46aced,
title = "Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention",
abstract = "Objectives 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.",
keywords = "PCI complications, percutaneous coronary intervention, stroke",
author = "Hoffman, {Scott J.} and Yee, {Alan Howe} and Slusser, {Joshua P.} and Rihal, {Charanjit S.} and Holmes, {David R.} and Rabinstein, {Alejandro A.} and Rajiv Gulati",
year = "2015",
month = "1",
day = "1",
doi = "10.1002/ccd.25678",
language = "English (US)",
volume = "85",
pages = "1033--1040",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",
number = "6",

}

TY - JOUR

T1 - Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention

AU - Hoffman, Scott J.

AU - Yee, Alan Howe

AU - Slusser, Joshua P.

AU - Rihal, Charanjit S.

AU - Holmes, David R.

AU - Rabinstein, Alejandro A.

AU - Gulati, Rajiv

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objectives 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.

AB - Objectives 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.

KW - PCI complications

KW - percutaneous coronary intervention

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=84928648194&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928648194&partnerID=8YFLogxK

U2 - 10.1002/ccd.25678

DO - 10.1002/ccd.25678

M3 - Article

VL - 85

SP - 1033

EP - 1040

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 6

ER -