An analysis of trends in the incidence and fatality of PCI strokes identified a progressive increase in the incidence of stroke as a complication of PCI, according to a letter published Oct. 23 in JACC.

Of 7,434,161 PCI patients captured by ACC’s CathPCI Registry between Oct. 1, 2009 and Sept. 30, 2020, Olufolahan Carrena, MD, et al., found that periprocedural strokes occurred in 22,741 patients, with the incidence rate nearly doubling over the course of the 11-year study period (21.92 strokes per 10,000 PCIs in the beginning vs. 41.15 strokes per 10,000 PCIs in the end). This increased risk for peri-PCI stroke persisted after adjusting for changes in patient risk factors over time.

Of patients with peri-PCI stroke, 36.4% were discharged to home, 20.9% died in-hospital, and 3.2% were discharged to a skilled nursing facility, extended care or rehabilitation center. The combined rate of fatality and discharge to hospice following peri-PCI stroke increased by 0.24% per every year.

While PCI stroke is overall infrequent, the incidence of this adverse event has steadily increased over time, indicating a need for peri-PCI stroke risk prevention and further assessment of current management strategies. The authors’ findings, in conjunction with work done by previous studies, have uncovered clinical implications for prevention. Carrena, et al., point to several approaches to manage risk of stroke complication.

“A general approach to risk assessment and stroke prevention with antiplatelet agents, adequate blood pressure control, and anticoagulation and statins may have the potential for decreasing this risk,” they state. “Similarly, a radial approach, judicious use of aspiration devices, a proper, adequate guiding catheter engagement, and meticulous aspiration and flushing of the thrombectomy device and guide catheter in between catheter, distal protection, or other PCI device exchanges are likely to decrease stroke risk in patients with a large thrombus burden or vein graft interventions.”

Clinical Topics: Anticoagulation Management, Cardiac Surgery, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Nonstatins, Novel Agents, Statins

Keywords: Thrombosis, Catheters, Thrombectomy, Rehabilitation Centers, Anticoagulants, Risk Assessment, Registries, Risk Factors, Stroke, Skilled Nursing Facilities, Hospices, Blood Pressure, Patient Discharge, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Platelet Aggregation Inhibitors, Percutaneous Coronary Intervention, Incidence, CathPCI Registry, National Cardiovascular Data Registries

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