W Brinjikji1, G Lanzino2, H J Cloft2, A H Siddiqui3, E Boccardi4, S Cekirge5, D Fiorella3, R Hanel6, P Jabbour7, E Levy3, D Lopes8, P Lylyk9, I Szikora10, D F Kallmes2. 1. From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) brinjikji.waleed@mayo.edu. 2. From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota. 3. Department of Neurosurgery (A.H.S., D.F., E.L.), State University of New York, Buffalo, New York. 4. Department of Neuroradiology (E.B.), Ospedale Niguarda-Ca' Granda, Milan, Italy. 5. Department of Radiology (S.C.), Hacettepe University Hospitals, Ankara, Turkey. 6. Department of Neurosurgery (R.H.), Baptist Neurological Institute, Jacksonville, Florida. 7. Department Neurosurgery (P.J.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 8. Department of Neurosurgery (D.L.), Rush University Medical Center, Chicago, Illinois. 9. Department of Interventional Neuroradiology (P.L.), Instituto Clínico ENERI, Buenos Aires, Argentina. 10. Department of Neuroradiology (I.S.), National Institute of Neurosciences, Budapest, Hungary.
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 χ(2) 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-six (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 of MCA aneurysms, 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 ± 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.
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 χ(2) 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-six (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 of MCA aneurysms, 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 ± 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.
Authors: Francesco Briganti; Giuseppe Leone; Mariano Marseglia; Giuseppe Mariniello; Ferdinando Caranci; Arturo Brunetti; Francesco Maiuri Journal: Neuroradiol J Date: 2015-08-27
Authors: J P Cruz; T Marotta; C O'Kelly; M Holtmannspötter; G Saliou; R Willinsky; T Krings; R Agid Journal: AJNR Am J Neuroradiol Date: 2014-05-29 Impact factor: 3.825
Authors: Tibor Becske; David F Kallmes; Isil Saatci; Cameron G McDougall; István Szikora; Giuseppe Lanzino; Christopher J Moran; Henry H Woo; Demetrius K Lopes; Aaron L Berez; Daniel J Cher; Adnan H Siddiqui; Elad I Levy; Felipe C Albuquerque; David J Fiorella; Zsolt Berentei; Miklós Marosfoi; Saruhan H Cekirge; Peter K Nelson Journal: Radiology Date: 2013-02-15 Impact factor: 11.105
Authors: Susana L Skukalek; Anne M Winkler; Jian Kang; Jacques E Dion; C Michael Cawley; Adam Webb; Mark J Dannenbaum; Albert J Schuette; Bill Asbury; Frank C Tong Journal: J Neurointerv Surg Date: 2014-11-10 Impact factor: 5.836
Authors: D F Kallmes; R Hanel; D Lopes; E Boccardi; A Bonafé; S Cekirge; D Fiorella; P Jabbour; E Levy; C McDougall; A Siddiqui; I Szikora; H Woo; F Albuquerque; H Bozorgchami; S R Dashti; J E Delgado Almandoz; M E Kelly; R Turner; B K Woodward; W Brinjikji; G Lanzino; P Lylyk Journal: AJNR Am J Neuroradiol Date: 2014-10-29 Impact factor: 3.825
Authors: F Cagnazzo; P-H Lefevre; I Derraz; C Dargazanli; G Gascou; D T di Carlo; P Perrini; R Ahmed; J F Hak; C Riquelme; A Bonafe; V Costalat Journal: AJNR Am J Neuroradiol Date: 2020-01 Impact factor: 3.825
Authors: T P Madaelil; J A Grossberg; B M Howard; C M Cawley; J Dion; R G Nogueira; D C Haussen; F C Tong Journal: AJNR Am J Neuroradiol Date: 2019-03-07 Impact factor: 3.825
Authors: M A Möhlenbruch; O Kizilkilic; M Killer-Oberpfalzer; F Baltacioglu; C Islak; M Bendszus; S Cekirge; I Saatci; N Kocer Journal: AJNR Am J Neuroradiol Date: 2017-08-10 Impact factor: 3.825
Authors: Sophia Hohenstatt; Christian Ulfert; Christian Herweh; Silvia Schönenberger; Jan C Purrucker; Martin Bendszus; Markus A Möhlenbruch; Dominik F Vollherbst Journal: Clin Neuroradiol Date: 2022-09-06 Impact factor: 3.156
Authors: Ali Sarrami-Foroushani; Toni Lassila; Michael MacRaild; Joshua Asquith; Kit C B Roes; James V Byrne; Alejandro F Frangi Journal: Nat Commun Date: 2021-06-23 Impact factor: 14.919