Silent Cerebral Infarcts After Cardiac Catheterization
Silent Cerebral Infarcts After Cardiac Catheterization
Background Single center studies using serial cerebral diffusion-weighted magnetic resonance imaging in patients having cardiac catheterization have suggested that cerebral microembolism might be responsible for silent cerebral infarct (SCI) as high as 15% to 22%. We evaluated in a multicenter trial the incidence of SCIs after cardiac catheterization and whether or not the choice of the arterial access site might impact this phenomenon.
Methods and Results Patients were randomized to have cardiac catheterization either by Radial (n = 83) or Femoral (n = 77) arterial approaches by experimented operators. The main outcome measure was the occurrence of new cerebral infarct on serial diffusion-weighted magnetic resonance imaging. Patient and catheterization characteristics, including duration of catheterization, were similar in both groups. The risk of SCI did not differ significantly between the Femoral and Radial groups (incidence of 11.7% versus 17.5%; OR, 0.85; 95% CI, 0.62–1.16; P = .31). At multivariable analysis, the independent predictors of SCI were the patient's higher height and lower transvalvular gradient.
Conclusions The high rate of SCI after cardiac catheterization of patients with aortic stenosis was confirmed, but its occurrence was not affected by the selection of Radial and Femoral access.
Acute symptomatic cerebral infarction following cardiac catheterization and percutaneous cardiovascular interventions is rare, but unperceived asymptomatic cerebral injury could occur at an unexpectedly high rate as detected by diffusion-weighted (DW) magnetic resonance imaging (MRI). Indeed, the high sensitivity of DW MRI suggests that this technique could allow an improved estimate of cerebral ischemic events associated with cardiovascular-catheter procedures. The use of transcranial Doppler (TCD) sonography has confirmed the recording of systematic microemboli entering the middle cerebral artery during various endovascular interventions, including cardiac catheterization. In the case of coronary bypass surgery, evidence indicates that microembolism is related to cognitive impairment, based on the results of neuropsychological testing. During cardiac catheterization, cerebral microembolism as detected by TCD has frequently been observed, but whether it is clinically relevant remains unknown. However, recent studies mentioned above have suggested that some of these microemboli could be related to silent cerebral embolisms responsible for acute brain injury, as documented by DW MRI.,
Nowadays, 2 vascular access sites are routinely used for percutaneous coronary intervention (PCI). Radial approach is associated with fewer local complications, and it has been suggested that, in particular, right Radial approach avoiding to cross the aortic arch could reduce the risk of atherosclerotic plaque mobilization especially developed at this level of the aorta. Based on these observations, we have conducted a prospective evaluation to look at the incidence of silent cerebral infarcts (SCIs) using serial DW-MRI in patients randomized either to radial or femoral access.
Abstract and Introduction
Abstract
Background Single center studies using serial cerebral diffusion-weighted magnetic resonance imaging in patients having cardiac catheterization have suggested that cerebral microembolism might be responsible for silent cerebral infarct (SCI) as high as 15% to 22%. We evaluated in a multicenter trial the incidence of SCIs after cardiac catheterization and whether or not the choice of the arterial access site might impact this phenomenon.
Methods and Results Patients were randomized to have cardiac catheterization either by Radial (n = 83) or Femoral (n = 77) arterial approaches by experimented operators. The main outcome measure was the occurrence of new cerebral infarct on serial diffusion-weighted magnetic resonance imaging. Patient and catheterization characteristics, including duration of catheterization, were similar in both groups. The risk of SCI did not differ significantly between the Femoral and Radial groups (incidence of 11.7% versus 17.5%; OR, 0.85; 95% CI, 0.62–1.16; P = .31). At multivariable analysis, the independent predictors of SCI were the patient's higher height and lower transvalvular gradient.
Conclusions The high rate of SCI after cardiac catheterization of patients with aortic stenosis was confirmed, but its occurrence was not affected by the selection of Radial and Femoral access.
Introduction
Acute symptomatic cerebral infarction following cardiac catheterization and percutaneous cardiovascular interventions is rare, but unperceived asymptomatic cerebral injury could occur at an unexpectedly high rate as detected by diffusion-weighted (DW) magnetic resonance imaging (MRI). Indeed, the high sensitivity of DW MRI suggests that this technique could allow an improved estimate of cerebral ischemic events associated with cardiovascular-catheter procedures. The use of transcranial Doppler (TCD) sonography has confirmed the recording of systematic microemboli entering the middle cerebral artery during various endovascular interventions, including cardiac catheterization. In the case of coronary bypass surgery, evidence indicates that microembolism is related to cognitive impairment, based on the results of neuropsychological testing. During cardiac catheterization, cerebral microembolism as detected by TCD has frequently been observed, but whether it is clinically relevant remains unknown. However, recent studies mentioned above have suggested that some of these microemboli could be related to silent cerebral embolisms responsible for acute brain injury, as documented by DW MRI.,
Nowadays, 2 vascular access sites are routinely used for percutaneous coronary intervention (PCI). Radial approach is associated with fewer local complications, and it has been suggested that, in particular, right Radial approach avoiding to cross the aortic arch could reduce the risk of atherosclerotic plaque mobilization especially developed at this level of the aorta. Based on these observations, we have conducted a prospective evaluation to look at the incidence of silent cerebral infarcts (SCIs) using serial DW-MRI in patients randomized either to radial or femoral access.
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