Potential embolization by atherosclerotic debris dislodged from aortic wall during cardiac catheterization:: Histological and clinical findings in 7,621 patients

Cerebrovascular Accident and Mesenteric Ischemia Following Diagnostic Coronary Angiography

“…Compared to mesenteric ischemia, stroke (ischemic or hemorrhagic) is a more known complication of coronary angiography. Most authors have reported factors such as debris or cholesterol particles which dislodge and cause stroke (6). However, our patient's angiography did not show coronary artery calcifications.…”

Silent and Apparent Cerebral Ischemia After Percutaneous Transfemoral Aortic Valve Implantation

“…35,36 It has been shown that scraping of aortic plaques occurs in Ͼ50% of percutaneous cardiac interventions and is more frequent with large than with small catheters. 36,37 Therefore, dislodgement of debris from ascending or arch atheroma during passage of the large-bore valve delivery catheters has the potential to add substantially to the high risk of cerebral embolization. Although dislodgement of aortic plaques is inherent to transfemoral TAVI, the transapical approach may potentially reduce this risk by obviating passage of the aortic arch with the large-bore delivery system and may thus be recommended in patients with large mobile arch atheroma.…”

Branch Retinal Artery Occlusion after Diagnostic Cardiac Catheterization.

“…Arterial procedures (surgery and cardiac catheterization) as well as pharmacologic treatment with an anticoagulant, such as warfarin or heparin, and fibrinolytic agents have been described as the precipitating factors, because they may prevent the formation of thrombi over ulcerated atheromatous plaques, allowing exposed cholesterol crystals to be scraped into the circulation. [9][10][11] Once a cholesterol embolism has been established, no effective specific treatment exists other than endarterectomy of the atherosclerotic carotid artery, if such a defect exists, to prevent recurrent embolic processes. 9) Patients who require catheterization but have noninvasive evidence of atherosclerotic aortic debris most likely should undergo an upper extremity approach, to reduce the likelihood of cholesterol embolization.…”

“…9) Patients who require catheterization but have noninvasive evidence of atherosclerotic aortic debris most likely should undergo an upper extremity approach, to reduce the likelihood of cholesterol embolization. 10,11) In high-risk patients, such as the elderly, noninvasive procedures (transesophageal echocardiography, magnetic resonance imaging, computed tomography, etc.) should be recommended to screen for the presence of atherosclerotic debris from the aorta.…”