Abstract WP91: Long-Term Risk of Stroke after Stent-Assisted Coiling of Unruptured Intracranial Aneurysms

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Setareh Salehi Omran ◽  
Babak B Navi ◽  
Hooman Kamel
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Cox Regression ◽  
Endovascular Coiling ◽  
Subdural Hemorrhage ◽  
Administrative Claims ◽  
Unruptured Intracranial Aneurysms ◽  
Secondary Outcomes

Background: Long-term comparative data are limited regarding stent-assisted coiling versus coiling alone for unruptured intracranial aneurysms. We compared the risks of ischemic stroke and intracranial hemorrhage after stent-assisted coiling versus coiling without stenting. Methods: Using administrative claims data on all admissions to nonfederal acute care hospitals in CA, FL, and NY from 2005-2013, we identified adult patients who underwent stent-assisted coiling or coiling without stenting for an unruptured intracranial aneurysm. Our primary outcome was a composite of ischemic stroke or intracranial hemorrhage (intracerebral, subarachnoid, or subdural hemorrhage). Our secondary outcomes were ischemic stroke and intracranial hemorrhage. Outcomes were ascertained by previously validated ICD-9-CM diagnosis codes. To focus on the long-term safety of these techniques, we excluded patients with an outcome during the index hospitalization. Kaplan-Meier survival statistics and Cox regression were used to compare stroke risk after stent-assisted coiling versus coiling alone. Results: We identified 5,398 patients (mean age, 58 [±13] years; 79% female) treated with endovascular coiling, of whom 254 (4.7%) underwent stent-assisted coiling. Over 4.2 (±2.0) years of follow-up, 357 outcomes were identified (205 ischemic strokes, 152 intracranial hemorrhages). By 8 years, the cumulative rate of stroke or hemorrhage was 8.5% (95% confidence interval [CI], 5.3-13.6%) with stent-assisted coiling versus 9.2% (95% CI, 7.8-10.9%) with coiling alone. Most outcomes occurred in the first year (3.6% after stent-assisted coiling versus 3.9% after coiling alone). After adjustment for demographics and vascular risk factors, the risk of ischemic stroke or intracranial hemorrhage was similar after stent-assisted coiling compared to coiling alone (hazard ratio [HR], 1.1; 95% CI, 0.7-1.7). Our results were unchanged when assessing the secondary outcomes of ischemic stroke (HR, 1.4; 95% CI, 0.8-2.4) or intracranial hemorrhage (HR, 0.7; 95% CI, 0.3-1.7). Conclusions: After uncomplicated coiling of an unruptured aneurysm, long-term rates of stroke and intracranial hemorrhage were similar for stent-assisted coiling and coiling without stenting.

Periprocedural complications of second-generation flow diverter treatment using Pipeline Flex for unruptured intracranial aneurysms: a systematic review and meta-analysis

2019 ◽  
Vol 11 (8) ◽  
pp. 817-824 ◽  
Author(s):  
Kartik Dev Bhatia ◽  
Hans Kortman ◽  
Emanuele Orru ◽  
Jesse M Klostranec ◽  
Vitor M Pereira ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Second Generation ◽  
Meta Analysis ◽  
Major Complication ◽  
Flow Diverter ◽  
Major Complications ◽  
Unruptured Intracranial Aneurysms ◽  
Symptomatic Intracranial Hemorrhage

BackgroundFlow diverters are a breakthrough treatment for large and giant intracranial aneurysms but carry a risk of periprocedural death or major stroke. Pipeline Flex is a second-generation device that is thought to have lower complication rates because of improvements in the delivery system as well as increased operator experience. Our objective was to analyze the risk of periprocedural death or major complications using Pipeline Flex for unruptured intracranial aneurysms.MethodsA systematic search of three databases was performed for studies of ≥10 treatments using Pipeline Flex for unruptured intracranial aneurysms (2014–2019) using PRISMA guidelines. Random effects meta-analysis was used to pool the rates of periprocedural (<30 days) death, major ischemic stroke, symptomatic intracranial hemorrhage, and minor stroke/transient ischemic attack.ResultsWe included eight studies reporting 901 treatments in 879 patients. Periprocedural mortality (<30 days) was 0.8% (5/901; 95% CI 0.4% to 1.5%; I2=0%). Rate of major complications (death, major ischemic stroke, or symptomatic intracranial hemorrhage) was 1.8% (14/901; 95% CI 1.0% to 2.7%; I2=0%). Aneurysm size ≥10 mm was a statistically significant predictor of a major complication (OR 6.4; 95% CI 2.0 to 20.7; p=0.002). Risk of a major complication in aneurysms <10 mm was 0.9% (95% CI 0.3% to 1.7%; I2=0%). The meta-analysis was limited by the predominance of anterior circulation aneurysms.ConclusionTreatment of unruptured intracranial aneurysms using the Pipeline Flex flow diverter has a low periprocedural risk of death (0.8%) or major complication (1.8%). The risk of a major complication is significantly higher for large/giant aneurysms (4.4%) and is very low for aneurysms <10 mm (0.9%).

Abstract 111: Comparison of Long-term Outcomes Associated with Endovascular Treatment Versus Surgical Treatment Among Medicare Beneficiaries with Unruptured Intracranial Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Saqib A Chaudhry ◽  
Wondwossen G Tekle ◽  
M Fareed K Suri
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Medicare Beneficiaries ◽  
Unruptured Intracranial Aneurysms ◽  
All Cause Mortality ◽  
Second Procedure

Objective: To determine the 5 year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment. Methods: The study included a representative sample of fee-for-service Medicare beneficiaries aged 65 years or older who underwent endovascular or surgical treatment for unruptured intracranial aneurysms between 1999 through 2010. The Medicare Provider Analysis and Review files were linked to the Center for Medicaid and Medicare Services denominator files for 2000-2010 to ascertain any new admission or mortality. Cox proportional hazards and Kaplan Meir survival analyses were used to assess the relative risk of all-cause mortality, new intracranial hemorrhage, or second procedure for patients treated with endovascular treatment compared with those treated with surgical treatment after adjusting for potential confounders. Results: A total of 1005 patients with unruptured intracranial aneurysms were treated with either endovascular (n=569) or surgical treatment (n=436) with post-procedure follow-up available for 4.64 (±2.98) years. The rate of immediate post-procedural neurological complications (8.7% vs. 3.2%, p<0.0001) and requirement for intraventricular catheter (2.8% vs. 0.7%, p=0.019) was higher among patients treated with surgery compared with those treated with endovascular treatment. The estimated 5 year survival was 93.6% and 95.8% in patients treated with surgical and endovascular treatments, respectively. After adjusting for age, gender, and race/ethnicity, relative risks of all-cause mortality (RR 0.5, 95% CI 0.3-0.9) and new intracranial hemorrhage (RR 0.4, 95% CI 0.2-0.8) were significantly lower with endovascular treatment. Conclusions: In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events, long-term all-cause mortality and new intracranial hemorrhages.

scholarly journals Safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysm

2018 ◽  
Vol 13 (7) ◽  
pp. 734-742 ◽  
Author(s):  
Yuji Shono ◽  
Hiroshi Sugimori ◽  
Ryu Matsuo ◽  
Yoshihisa Fukushima ◽  
Yoshinobu Wakisaka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Antithrombotic Therapy ◽  
Intracranial Aneurysms ◽  
Poor Functional Outcome ◽  
Thrombolytic Agents ◽  
Unruptured Intracranial Aneurysms

Background The safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysms remains unclear. Aims This study was performed to determine whether treatment with antiplatelets, anticoagulants, or intravenous thrombolytic agents is safe for patients with acute ischemic stroke and unruptured intracranial aneurysms. Methods Among 9149 patients with acute ischemic stroke enrolled in the Fukuoka Stroke Registry from June 2007 to December 2014, 8857 patients with data on cerebrovascular imaging and three-month outcomes were included in this study. The frequency of adverse events, including intracranial hemorrhage, symptomatic intracranial hemorrhage, and in-hospital mortality, was compared between patients with and without unruptured intracranial aneurysms. The risk of a poor functional outcome (modified Rankin scale score of ≥3) at three months after stroke onset was estimated after adjusting for confounding factors by logistic regression analysis. Results Unruptured intracranial aneurysms were identified in 412 (4.7%) patients, and the mean diameter was 4.1 ± 3.2 mm. There was no significant difference in the frequency of any adverse events between patients with and without unruptured intracranial aneurysms among the overall patients or patients receiving antiplatelets, anticoagulants, or intravenous thrombolytic agents. The odds ratios of a poor functional outcome were not significantly higher in the presence of unruptured intracranial aneurysms, even in patients undergoing antiplatelet therapy, anticoagulation therapy, or intravenous thrombolysis. Conclusions These findings suggest that unruptured intracranial aneurysms are not associated with increased risks of adverse events or poor functional outcomes even after antithrombotic therapy for acute ischemic stroke. However, accumulation of cases is required to verify these findings.

scholarly journals Hospital volume and 1-year mortality after treatment of intracranial aneurysms: a study based on patient registries in Scandinavia

2015 ◽  
Vol 123 (3) ◽  
pp. 631-637 ◽  
Author(s):  
Haakon Lindekleiv ◽  
Ellisiv B. Mathiesen ◽  
Olav H. Førde ◽  
Tom Wilsgaard ◽  
Tor Ingebrigtsen
Keyword(s):  
Intracranial Aneurysms ◽  
Hospital Volume ◽  
Cox Regression ◽  
Patient Registries ◽  
Unruptured Aneurysms ◽  
Risk Of Death ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Long Term Mortality

OBJECT The object of this study was to examine the relationship between hospital volume and long-term mortality after treatment of intracranial aneurysms. METHODS The authors identified patients treated for intracranial aneurysms between 2002 and 2010 from patient registries of Denmark, Norway, and Sweden, and linked to data on 1-year mortality from the population registry of each country. Cox regression models were used to relate hospital volume to the risk of death and adjusted for potential confounders (age, sex, year of treatment, Charlson comorbidity index, country, and surgical treatment). RESULTS The authors identified 5773 patients with ruptured and 1756 patients with unruptured intracranial aneurysms, treated at 15 hospitals. One-year mortality rates were 15.6% for patients with ruptured aneurysms and 2.7% for patients with unruptured aneurysms. No consistent relationship was found between hospital volume and 1-year mortality for ruptured aneurysms in the unadjusted analyses, but higher hospital volume was associated with increased mortality in the analyses adjusted for potential confounders (hazard ratio [HR] per 10-patient increase 1.04, 95% CI 1.00–1.07). There was a trend toward a lower mortality rate in higher-volume hospitals after treatment for unruptured intracranial aneurysms, but this was not statistically significant after adjustment for potential confounders (HR per 10-patient increase 0.69, 95% CI 0.42–1.10). There were large variations in mortality after treatment for both ruptured and unruptured intracranial aneurysms across hospitals and between the Scandinavian countries (p < 0.01). CONCLUSIONS The findings in this study did not confirm a relationship between higher hospital volume and reduced long-term mortality after treatment of ruptured intracranial aneurysms. Prospective registries for evaluating outcomes after aneurysm treatment are highly warranted.

scholarly journals The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil

2016 ◽  
Vol 125 (3) ◽  
pp. 705-712 ◽  
Author(s):  
Wataru Ishida ◽  
Masayuki Sato ◽  
Tatsuo Amano ◽  
Yuji Matsumaru
Keyword(s):  
Multivariate Analysis ◽  
Packing Density ◽  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Long Term Outcomes ◽  
Aneurysm Size ◽  
Unruptured Intracranial Aneurysms ◽  
Coil Volume

OBJECTIVE The importance of a framing coil (FC)—the first coil inserted into an aneurysm during endovascular coiling, also called a lead coil or a first coil—is recognized, but its impact on long-term outcomes, including recanalization and retreatment, is not well established. The purposes of this study were to test the hypothesis that the FC is a significant factor for aneurysmal recurrence and to provide some insights on appropriate FC selection. METHODS The authors retrospectively reviewed endovascular coiling for 280 unruptured intracranial aneurysms and gathered data on age, sex, aneurysm location, aneurysm morphology, maximal size, neck width, adjunctive techniques, recanalization, retreatment, follow-up periods, total volume packing density (VPD), volume packing density of the FC, and framing coil percentage (FCP; the percentage of FC volume in total coil volume) to clarify the associated factors for aneurysmal recurrence. RESULTS Of 236 aneurysms included in this study, 33 (14.0%) had recanalization, and 18 (7.6%) needed retreatment during a mean follow-up period of 37.7 ± 16.1 months. In multivariate analysis, aneurysm size (odds ratio [OR] = 1.29, p < 0.001), FCP < 32% (OR 3.54, p = 0.009), and VPD < 25% (OR 2.96, p = 0.015) were significantly associated with recanalization, while aneurysm size (OR 1.25, p < 0.001) and FCP < 32% (OR 6.91, p = 0.017) were significant predictors of retreatment. VPD as a continuous value or VPD with any cutoff value could not predict retreatment with statistical significance in multivariate analysis. CONCLUSIONS FCP, which is equal to the FC volume as a percentage of the total coil volume and is unaffected by the morphology of the aneurysm or the measurement error in aneurysm length, width, or height, is a novel predictor of recanalization and retreatment and is more significantly predictive of retreatment than VPD. To select FCs large enough to meet the condition of FCP ≥ 32% is a potential relevant factor for better long-term outcomes. These findings support our hypothesis that the FC is a significant factor for aneurysmal recurrence.

Comparison of Long-term Outcomes Associated With Endovascular Treatment vs Surgical Treatment Among Medicare Beneficiaries With Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 75 (4) ◽  
pp. 380-387 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Saqib A. Chaudhry ◽  
Wondwossen G. Tekle ◽  
M. Fareed K. Suri
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Medicare Beneficiaries ◽  
Long Term Outcomes ◽  
Unruptured Intracranial Aneurysms ◽  
All Cause Mortality ◽  
Second Procedure

Abstract BACKGROUND: Long-term outcomes associated with endovascular and surgical treatments for unruptured intracranial aneurysms are not well studied to date. OBJECTIVE: To determine the 5-year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment. METHODS: The study cohort included a representative sample of fee-for-service Medicare beneficiaries aged ≥65 years who underwent endovascular or surgical treatment for unruptured intracranial aneurysms with postprocedure follow-up of 4.7 (±3.0) years. Cox proportional hazards analysis was used to assess the relative risk (RR) of all-cause mortality, new intracranial hemorrhage, or second procedure for patients who underwent endovascular treatment compared with those who underwent surgical treatment after adjusting for potential confounders. The 5-year survival was estimated for both treatment groups by using Kaplan-Meier survival methods. RESULTS: A total of 688 patients with unruptured intracranial aneurysms were treated with either endovascular (n = 398) or surgical treatment (n = 290). The rate of immediate postprocedural neurological complications (10.3% vs 3.5%, P = .001) was higher among patients treated with surgery than among those who underwent endovascular treatment. The estimated 5-year survival was 92.8% and 94.8% in patients who underwent surgical and endovascular treatments, respectively. After adjusting for age, sex, and race/ethnicity, the RRs of all-cause mortality (RR, 0.6; 95% confidence interval, 0.3-1.1) and new intracranial hemorrhage (RR, 0.4; 95% confidence interval, 0.2-0.8) were lower with endovascular treatment. CONCLUSION: In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events and long-term all-cause mortality and new intracranial hemorrhages.

Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion

2021 ◽  
pp. 159101992110259
Author(s):  
Kainaat Javed ◽  
Santiago R Unda ◽  
Ryan Holland ◽  
Adisson Fortunel ◽  
Rose Fluss ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Aneurysms ◽  
Statistical Significance ◽  
Alpha Angle ◽  
Flow Diversion ◽  
P Value ◽  
Hemorrhagic Complication ◽  
Unruptured Intracranial Aneurysms ◽  
Hemorrhagic Complications ◽  
Groin Hematoma

Introduction Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion. Methods This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results. Results Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%. Conclusion The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

scholarly journals Characteristics of ischemic stroke and intracranial hemorrhage in patients with nephrotic syndrome

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wen-Yi Huang ◽  
Chun-Wei Chang ◽  
Chiung-Mei Chen ◽  
Kuan-Hsing Chen ◽  
Chien-Hung Chang ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Chang Gung Memorial Hospital ◽  
Cerebral Stroke ◽  
Research Database ◽  
Anterior Circulation ◽  
Cox Regression Analysis

Abstract Background The incidence of cerebral stroke, including ischemic infarction and intracranial hemorrhage (ICH), increases in patients with nephrotic syndrome (NS). However, the clinical characteristics of patients with NS and stroke remain elusive. We aimed to investigate the clinical presentation and prognosis among patients with NS and ischemic stroke (IS) or ICH. Methods We conducted a population-based retrospective cohort study of patients with NS and acute stroke using the Chang Gung Research Database of Taiwan from January 1, 2001, to December 31, 2017. The participants were recruited from the 7 branches of Chang Gung Memorial Hospital. Results A total of 233 patients with IS and 57 patients with ICH were enrolled. The median age was 60 (52–70) years. The prevalence rates of hyperlipidemia, hyperuricemia, and smoking were higher in IS than in ICH. IS demonstrated lower white blood cell count (7.80 vs. 8.92 × 109/L) and high-sensitivity C-reactive protein level (33.42 vs. 144.10 nmol/L) and higher cholesterol (5.74 vs. 4.84 mmol/L), triglyceride (1.60 vs. 1.28 mmol/L), and albumin (24 vs. 18 g/L) levels compared with ICH. The dependent functional status and 30-day mortality were higher in ICH than in IS. The risk factors for 30-day mortality for patients with NS and stroke were coronary artery disease (CAD), ICH, and total anterior circulation syndrome. The multivariate Cox regression analysis revealed that CAD was positively associated with 30-day mortality in patients with IS (hazard ratio 24.58, 95 % CI 1.48 to 408.90). In patients with ICH, CAD and subarachnoid hemorrhage were positively associated with 30-day mortality (hazard ratio 5.49, 95 % CI 1.54 to 19.56; hazard ratio 6.32, 95 % CI 1.57 to 25.53, respectively). Conclusions ICH demonstrated a higher risk of dependence and 30-day mortality compared with IS in patients with NS. Intensive monitoring and treatment should be applied particularly in patients with NS and ICH.

scholarly journals Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ting-Ann Wang ◽  
Tzy-Haw Wu ◽  
Shin-Liang Pan ◽  
Hsiu-Hsi Chen ◽  
Sherry Yueh-Hsia Chiu
Keyword(s):  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Controlled Trial ◽  
Stroke Recurrence ◽  
Long Term Effects ◽  
Stroke Patients ◽  
Double Blind ◽  
Term Survival

AbstractAspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96–3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41–0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1–2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.

scholarly journals Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chia-Yu Hsu ◽  
Chun-Yu Cheng ◽  
Jiann-Der Lee ◽  
Meng Lee ◽  
Bruce Ovbiagele
Keyword(s):  
Valproic Acid ◽  
Ischemic Stroke ◽  
Cox Regression ◽  
Population Based ◽  
Primary Diagnosis ◽  
Research Database ◽  
Post Stroke ◽  
Risk Of Death ◽  
Index Stroke

Abstract Objective We aim to compare the effect of long-term anti-seizure medication (ASM) monotherapy on the risk of death and new ischemic stroke in patients with post-stroke epilepsy (PSE). Patients and methods We identified all hospitalized patients (≥ 20 years) with a primary diagnosis of ischemic or hemorrhagic stroke from 2001 to 2012 using the National Health Insurance Research Database in Taiwan. The PSE cohort were defined as the stroke patients (1) who had no epilepsy and no ASMs use before the index stroke, and (2) who had epilepsy and ASMs use after 14 days from the stroke onset. The patients with PSE receiving ASM monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new ASM groups. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) of death and new ischemic stroke within 5 years across all groups, using the new ASM group as the reference. Results Of 6962 patients with PSE using ASM monotherapy, 3917 (56 %) were on phenytoin, 1623 (23 %) on valproic acid, 457 (7 %) on carbamazepine, and 965 (14 %) on new ASMs. After adjusting for confounders, compared with new ASM users, phenytoin users had a higher risk of death in 5 years (HR: 1.64; 95 % CI: 1.06–2.55). On the other hand, all ASM groups showed a similar risk of new ischemic stroke in 5 years. Conclusions Among patients with PSE on first-line monotherapy, compared to new ASMs, use of phenytoin was associated with a higher risk of death in 5 years.

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