Cerebral emboli during left heart catheterization may cause acute brain injury

Lund, Christian; Nes, Ragnhild Bang; Ugelstad, Torhild Pynten; Due‐Tønnessen, Paulina; Andersen, Rune; Hol, Per Kristian; Brucher, Rainer; Russell, David

doi:10.1093/eurheartj/ehi148

Cited by 144 publications

(141 citation statements)

References 28 publications

(30 reference statements)

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“…Atherosclerotic thromboembolism due to catheter manipulation, thrombus formation on the catheter, air embolism and contrast agent may cause cerebral injury (12)(13)(14)(15). Moreover, increase in incidence of stroke in patients with history of PCI was reported in a previous study (10).…”

Section: Introductionsupporting

confidence: 56%

“…SNI was evaluated by MRI in prior studies (7,9,10). MRI is the most sensitive non-invasive radiological method for the evaluation of cerebral anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…However PCI related complications including heart chamber perforation, myocardial infarction (MI), arrhythmia, vascular complications, dye allergy, hemodynamic derangements and stroke may ensue (5,6). Retrospective data analysis revealed that 0.11-0.38% of patients undergoing CAG experienced clinically evident cerebral infarction, while the incidence of SNI was 13-22% (7)(8)(9)(10). SNI is described in 18.5-23% of patients after cerebral angiography (11,12).…”

Section: Introductionmentioning

confidence: 99%

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Cardio-ankle vascular index may be an important marker of silent neuronal injury after percutaneous coronary angiography and intervention: a prospective observational study on diagnostic accuracy

Aykan¹,

Gökdeniz²,

Bektaş³

et al. 2014

Anadolu Kardiyol Derg

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Objective: The relationship between silent neuronal injury (SNI) and arterial stiffness assessed by cardio-ankle vascular index (CAVI) has not been evaluated in patients treated with coronary angiography and intervention due to acute coronary syndrome (ACS). The aim of this study is to evaluate the value of CAVI in prediction of SNI after percutaneous coronary angiography and intervention in patients presented with ACS. Methods: Eighty-three consecutive patients presented with ACS, who underwent percutaneous coronary angiography and intervention, were included in this prospective observational study on diagnostic accuracy. Neuron specific enolase (NSE) was studied before and 18 hour after the coronary angiography and intervention. CAVI was measured by VaSera-1000 instrument. Clinical and echocardiographic characteristics were analyzed and independent predictors of SNI were evaluated. Chi-square, Student t-test, Mann-Whithney U test, correlation analysis and logistic regression analysis was used for statistical analysis. Results: NSE levels significantly increased after cardiac catheterization (9.82±3.22 mg/dL vs. 13.15±8.55 mg/dL, p<0.001). CAVI (OR=2.992, 95% CI: 1.494-5.713, p=0.002), left ventricular ejection fraction (LVEF) (OR=0.911, 95% CI: 0.843-0.983, p=0.017) and undergoing percutaneous coronary intervention (OR=4.430, 95% CI: 1.034-18.97, p=0.045) were the independent predictors of SNI in logistic regression analysis. The cut-off value to show SNI for CAVI was 10.45 (sensitivity=71.8%, specificity=91.5%) in receiver operator charecteristic (ROC) curve analysis. The area under curve was 0.832 (95% CI=0.746-0.918, p<0.001). Conclusion: Besides undergoing PCI and having LVEF, measurement of CAVI may be a useful tool for predicting the development of SNI after percutaneous coronary angiography and intervention in patients with ACS. (Anadolu Kardiyol Derg 2014; 14: 606-11)

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Section: Introductionsupporting

confidence: 56%

“…SNI was evaluated by MRI in prior studies (7,9,10). MRI is the most sensitive non-invasive radiological method for the evaluation of cerebral anatomy.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cardio-ankle vascular index may be an important marker of silent neuronal injury after percutaneous coronary angiography and intervention: a prospective observational study on diagnostic accuracy

Aykan¹,

Gökdeniz²,

Bektaş³

et al. 2014

Anadolu Kardiyol Derg

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“…However, phases that are known to have high numbers of microemboli, such as ventriculography and catheter flushings, may be more hazardous to the brain than to the coronary circulation. 37 Our method of detecting microemboli also does not differentiate between air microbubbles and solid materials. In the present experimental setting for simulation of PCI, we did not find air microbubbles after repeated balloon deflations that might be generated by excavations.…”

Section: Study Limitationsmentioning

confidence: 91%

Detection of Coronary Microembolization by Doppler Ultrasound in Patients With Stable Angina Pectoris Undergoing Elective Percutaneous Coronary Interventions

et al. 2007

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Background-Intracoronary Doppler guidewires can be used for real-time detection and quantification of microembolism during percutaneous coronary interventions (PCIs). We investigated whether the frequency of Doppler-detected microembolism is related to the incidence of myonecrosis during elective PCI. Methods and Results-The study population included 52 consecutive patients (aged 64Ϯ10 years; 36 men, 16 women) with coronary artery disease who underwent elective PCI of a single-vessel stenosis. Using intracoronary Doppler ultrasound, we compared the frequency of microembolism during PCI in 22 patients with periprocedural non-STsegment elevation myocardial infarctions (pNSTEMI) and 30 patients without pNSTEMI. The 2 groups were comparable with regard to their clinical and procedural characteristics. In the group with pNSTEMI, the total number of coronary microemboli after PCI (27Ϯ10 versus 16Ϯ8, PϽ0.001) was higher than in the group without pNSTEMI. Although high-sensitivity C-reactive protein plasma levels were similar before PCI (2.9Ϯ2.2 versus 3.4Ϯ1.7 mg/L, PϭNS), they were higher in the group with pNSTEMI after PCI (12.6Ϯ10.

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“…Although conventional coronary angiography is the reference method for detection of bypass graft disease, it is an invasive and time-consuming procedure that carries potential risk of catheter-related complications [2,3]. Rapid advances in multislice computed tomography angiography (CTA) have facilitated noninvasive visualization of coronary arteries and bypass grafts with greater diagnostic accuracy [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Dual-source computed tomography angiography in patients after bypass grafting – comparison with invasive coronary angiography

Kępka¹,

Opolski²,

Kruk³

et al. 2010

pwki

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A b s t r a c tBackground: Assessment of bypass grafts by invasive coronary angiography (ICA) is bothersome and often requires extra procedure time, contrast load, and radiation exposure.Aim: To evaluate the ability of dual-source computed tomography angiography (CTA) to detect significant graft disease in symptomatic patients after coronary artery bypass grafting (CABG).Methods: Thirty (26 men, mean age 66 ± 9 years) consecutive post-CABG patients from the prospective ANIN Computed Tomography Angiography Registry who underwent both dual-source CTA and ICA for suspected graft disease were included in the analysis. Coronary artery bypass grafts, anastomotic sites, and distal runoffs with a diameter of ≥ 1.5 mm were evaluated for the presence of significant stenoses (≥ 50% diameter reduction). Invasive coronary angiography served as a reference standard, and was performed within 30 days of dual-source CTA.Results: A total of 58 bypass grafts with 56 anastomotic sites, and 54 distal runoffs were evaluable both in dual-source CTA and ICA. Sensitivity, specificity, and positive and negative predictive values of dual-source CTA for the detection of significant lesions in bypass grafts were 100%, 92%, 86%, and 100%, respectively. In anastomotic sites, dual-source CTA detected significant stenosis with a sensitivity and specificity of 100% and 96%, respectively. If analysis was restricted to distal runoff segments, sensitivity and specificity were 50% and 98%, respectively. On a per-patient basis, all patients with at least one significant graft stenosis on ICA were correctly classified using dual-source CTA.Conclusions: Dual-source CTA permits the reliable assessment of bypass graft disease with high diagnostic accuracy and can be used in clinical routine as a noninvasive test to rule out suspected graft dysfunction in symptomatic post-CABG patients.Key words: dual-source computed tomography angiography, coronary artery bypass grafts, anastomotic sites, distal runoff segments S t r e s z c z e n i e Wstęp: Ocena pomostów aortalno-wieńcowych w inwazyjnej koronarografii często wiąże się z wydłużeniem czasu badania, podaniem dużej ilości kontrastu oraz większą dawką skuteczną promieniowania.Cel: Ocena dokładności dwuźródłowej tomografii komputerowej tętnic wieńcowych (CTA) w wykrywaniu istotnych zwężeń w pomostach u chorych z objawami po operacji pomostowania aortalno-wieńcowego (CABG).Metodyka: Do analizy włączono kolejnych 30 chorych (26 mężczyzn, średni wiek 66 ± 9 lat) po CABG z prospektywnego Rejestru Tomografii Komputerowej Tętnic Wieńcowych ANIN, u których wykonano badanie CTA oraz inwazyjną koronarografię. Ocenie poddano pomosty aortalno-wieńcowe, anastomozy oraz dystalne segmenty tętnic natywnych o średnicy ≥ 1,5 mm. Za istotne zwężenie przyjęto zmianę ≥ 50% redukcji światła naczynia. Wyniki analizy w CTA zostały porównane z inwazyjną koronarografią jako metodą referencyjną. Odstęp czasowy między CTA a koronarografią wyniósł ≤ 30 dni.Wyniki: Do analizy włączono 58 pomostów, 56 anastomoz oraz 54 segmenty dystalne ...

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Cerebral emboli during left heart catheterization may cause acute brain injury

Abstract: During left heart catheterization, cerebral microemboli, especially those which are solid, may damage the brain. Cardiac catheterization may therefore pose a greater risk for the brain than previously acknowledged.

Cited by 144 publications

References 28 publications

Cardio-ankle vascular index may be an important marker of silent neuronal injury after percutaneous coronary angiography and intervention: a prospective observational study on diagnostic accuracy

Cardio-ankle vascular index may be an important marker of silent neuronal injury after percutaneous coronary angiography and intervention: a prospective observational study on diagnostic accuracy

Detection of Coronary Microembolization by Doppler Ultrasound in Patients With Stable Angina Pectoris Undergoing Elective Percutaneous Coronary Interventions

Dual-source computed tomography angiography in patients after bypass grafting – comparison with invasive coronary angiography

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